two e/m

If my Hospitalist bills a 99223 in the morning and the patient later crashes and his partner comes back in the afternoon and performs critical care 99291, which service gets the 25 modiifer?
Sandy Rieckman, CPC

re: two e/m

Not sure it's needed 99223 is inpt visit and 99291 is outpt. If, I had to pick one it would be 99291. I'd wait for the eob's and see if there is a conflict.

re: two e/m

99223 and 99291 are both inpatient codes.

If they are partners then only one e/m can be billed a day. What you would do is take both of the provider's notes and combine the documentation into one and bill the Critical Care code. Make sure that the time is documented as well since Critical Care codes are time based and make sure the notes reference each other.

re: two e/m

Per CMS 30.6.12 section H both E/M are payable:

H. Critical Care Services and Other Evaluation and Management Services Provided
on Same Day
When critical care services are required upon the patient's presentation to the hospital
emergency department, only critical care codes 99291 - 99292 may be reported. An
emergency department visit code may not also be reported.
When critical care services are provided on a date where an inpatient hospital, hospital
emergency department, or office/outpatient evaluation and management service was
furnished earlier on the same date at which time the patient did not require critical care,
both the critical care and the previous evaluation and management service may be paid.