Critical care discharge

If a patient has a full visit (45 minutes) in ICU, and is later discharged home(strange I know), Is it appropriate to bill 99291 for that day, or must I bill the discharge?

Bill the better paying one

But are you sure that it truly was critical care and not just routine care in the critical care unit? I guess anaphylactic shock can be pretty scary and then clear up enough for a discharge...

critical care and discharge on the same calendar date

I have only reviewed a few of these. First, if the patient dies, you would bill only for the critical care, assuming your physician was providing critical care.

If the patient gets well and is discharged, you would bill only one: the critical care or discharge service. I have only reviewed two or three of these combinations in my auditing and in all of them, the patient was not still receiving critical interventions/wasn't critically ill on the last day. I suppose the doctors can tell us when it might happen, but I urge caution.

thank you!!

Do you have documentation that would back this up, I have looked at M'care's web site and see nothing on the question of critical care and discharge.

[I have only reviewed a few of these. First, if the patient dies, you would bill only for the critical care, assuming your physician was providing critical care.

If the patient gets well and is discharged, you would bill only one: the critical care or discharge service. I have only reviewed two or three of these combinations in my auditing and in all of them, the patient was not still receiving critical interventions/wasn't critically ill on the last day. I suppose the doctors can tell us when it might happen, but I urge caution.]

re: Do you have documentation that would back this up, I have looked at M'care's web site and see nothing on the question of critical care and discharge.

CPT® Asst Dec. 1998 "A hospital inpatient code or emergency dept service may be reported in addition the the critical care service code(s) if both services are provided by the same physician on the same day."...

..."The modifier -25 may be appended to the hospital inpatient service code or the ED service code to indicate that a significant separately identifiable E/M service was performed by the same physician on the same day critical care services were provided"

In other words, if the physician rounded in the morning, and the pt had critical care service event in the afternoon, or, as in your case, critical care in the morning and discharge or separate E/M service (with separate documentation) in the afternoon, apply the -25 modifier.