Can a provider submit a hospital inpatient, office or outpatient evaluation on the same calendar date as a critical service?

Answer 
When a hospital inpatient, office or outpatient evaluation and management service (E/M) is furnished on a calendar date at which time the patient does not require critical care services and the patient subsequently requires critical care, both the critical care service (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 on the same date as critical care services when provided by the same provider to the same patient.

During critical care management of a patient, services that do not meet the level of critical care, shall be reported using a subsequent hospital care code: CPT code range 99231-99233.

Both initial hospital care (CPT codes 99221-99223) and subsequent hospital care codes are “per diem” services and may be reported only once per day by the same provider or providers of the same specialty from the same group practice.

Physicians and qualified nonphysician practitioners (NPPs) are advised to retain documentation of both hospital care and critical care visits. The retained documentation shall support claims for critical care services when the same provider(s) 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.

Resource: CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.9.A (PDF, 1.05 MB)

 

 

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