If, however, there is a medically necessary reason for a second visit on the same date but the patient does not meet criteria for critical care services, the second hospitalist could bill for a subsequent visit. You shouldn’t be billing a second visit, for example, if a patient’s condition is stable and no new concerns have arisen since the first visit that day. You should report CPT code 99291 for the first 30–74 minutes of critical care time spent, then bill code 99292 for each additional 30 minutes after that 74-minute threshold is reached.īut be sure there is a medically necessary reason for a patient to receive two visits in one day. If that is the case, the total time spent providing critical care on the same calendar day is what drives the codes billed. Next, although you didn’t say so, I assume both doctors are in the same group and specialty and bill under the same tax ID number. Be sure your physicians understand what qualifies as critical care: “a critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.” But I don’t think we can bill two critical care visits on one calendar date.Ī couple of things: First, just because a patient’s condition may qualify him or her for a critical care visit in the morning doesn’t mean it qualifies him or her for a second critical care visit later that day. The first sees the patient in the morning, while the second sees the patient that night.Ĭan we bill both visits on the same day? Some of us believe the first doctor should bill a 99291, while the second should bill a 99292. Another doctor the same day also bills critical care for the same patient for 60 minutes. One physician documents critical care and spends a total of 50 minutes with a patient. Here’s an issue our hospitalists go back and forth about all the time. It would be OK to bill the discharge for the date the discharge service took place, as well as a subsequent visit the next day.Īs for when you should cancel an original discharge: only if a patient’s condition suddenly takes a turn for the worse and it becomes medically necessary for him or her to stay as an inpatient. However, if the patient develops a medical problem- fever, vomiting-after the discharge has been performed and has to remain in the hospital, the attending physician should bill a subsequent hospital care visit at the appropriate level for each date of service. But he or she shouldn’t bill any additional visits because there are no medically necessary reasons for those. If the patient remains in the hospital for nonmedical reasons (waiting for an available bed, for example, at a nursing facility) after the discharge is performed, the attending physician can continue to see the patient. If you want a reference to share with your doctors, steer them to the CMS Claims Processing Manual 100-4, chapter 12, section 30.6.9.2, sub-section B, which provides those details. You need to bill hospital discharge services on the date the face-to-face discharge service was performed, even if the patient does not leave that day. ![]() My questions: If a patient stays in the hospital beyond the initial discharge date for either a nonmedical or medical reason, what day should we bill the discharge? The day the patient was originally supposed to be discharged or the day the patient actually leaves? You need to bill hospital discharge services on the date the face-to-face discharge service was performed.Īnd what’s the rule for billing physician services on the additional day(s)? One of our doctors believes we should be billing subsequent visits until the day the patient actually leaves and then bill a discharge, even if the patient stayed for a nonmedical reason. ![]() My understanding is that doctors can bill a subsequent visit for an additional day only if a patient remains in the hospital for a medical reason such as a fall or for medication adjustments. ![]() But if the patient stays another day for a nonmedical reason-insurance problems or no ride home-and a physician sees that patient on that additional day, he or she wouldn’t be able to bill any services. ![]() I am under the impression that when a discharge date is set, a discharge summary should be dated the same day the discharge order is written. HOW DO YOU BILL a discharge when patients don’t leave the same day the discharge service is performed? Here are answers to questions we’ve received from readers.
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