Forum - Questions & Answers

Jan 7th, 2010 - vonne 3 

inital admission billed as critical care

With the elimination of the consult codes w/ Medicare the hospitalists question what they would do when they perform critical care in the ED and admit the patient to the ICU unit. They normally bill the critical care code, but with the new requirement of the modifier AI, what would they bill properly? They need to bill critical care (99291) when that is what it is, but the AI only goes w/ 21/22/23 codes.

Thanks!
Vonne

Jan 7th, 2010 - nmaguire   2,606 

critical care

You bill what you do, if you perform critical care, continuous or non-continuous during calendar day, count face-to-face time with patient. The 99221-99223 is for the Initial encounter and if they bill cc, they already had the initial encounter. The time that a practitioner can report as critical care is the time spent engaged in work directly related to the individual patient’s care whether that time was spent either at the immediate bedside or elsewhere on the floor or unit. Instances when a critically ill patient is seen for the first time as an admission E/M (evaluation and management 99221-99223 AI) and this service is followed by (ex, different time of day) a period of critical care service, the physician may bill using either of these options:
< Combine and bill all services as critical care services using time spent for defining billing charges, especially if the care was initiated as critical care.
< Bill the admission E/M if a separate service from the critical care service, with modifier 25. If this method is used, the time spent in performing the admission (AI modifier) cannot be included in the critical care time billed. Furthermore, the admission service billed must meet all of the documentation and time requirements listed under CPT of those services.You can bill a critical care code (99291) on the same day as an admit or other service if they were at different times and are separately documented.

Jan 7th, 2010 - Vonne 3 

critical care

Thanks so much. I had the understanding that if the MD was the admitting MD that they must show that and who could they if they bill 99291 as their admission code. So, from your response, I see that the "AI" modifier is not "required" on every admission like I thought it was.

Jan 7th, 2010 -

Here is another example

An orthopedist electively admits a patient for knee replacement. The hospitalist is called to see the patient and manage diabetes. Here the ortho gets paid in her global surgery payment for everything and does not report an initial hospital visit. The internist does report an initial visit but he is not the managing physician so he does not report the -AI. Hence, no -AI at all for this patient.



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