Hospital visits billed on same day - two physician

A. Hospital Visit and Critical Care on Same Day
When a hospital inpatient or office/outpatient evaluation and management service (E/M) are furnished on a calendar date at which time the patient does not require critical care an the patient subsequently requires critical care both the critical Care Services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service. Hospital emergency department services are not paid for the same date as critical care services when provided by the same physician to the same patient. During critical care management of a patient those services that do not meet the level of critical care shall be reported using an inpatient hospital care service with CPT Subsequent

B Hospital Care using a code from CPT code range 99231 – 99233.
Both Initial Hospital Care (CPT codes 99221 – 99223) and Subsequent Hospital Care codes are “per day” services and may be reported only once per day by the same physician or physicians of the same specialty from the same group practice. Physicians and qualified nonphysician practitioners (NPPs) are advised to retain documentation for discretionary contractor review should claims be questioned for both hospital care and critical care claims. The retained documentation shall support claims for critical care when the same physician or physicians of the same specialty in a group practice report critical care services for the same patient on the same calendar date as other E/M services.

C. Hospital Visits Same Day But by Different Physicians
In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, carriers do not pay physician B for the second visit. The hospital visit descriptors include the phrase “per day” meaning care for the day. If the physicians are each responsible for a different aspect of the patient’s care, pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses. There are circumstances where concurrent care may be billed by physicians of the same specialty.


froz said...

There are so many such trivial yet important issues that medical billers and practitioners miss out on. a site that helped me keep track and understand such issues is

suzi said...

A medical biller or coder can help you to process the bills faster.

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