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Critical Care vs. Discharge Summary

Pamela Posted Mon 05th of March, 2018 09:08:18 AM
I have a question that needs explanation. My physician spent 480 minutes (according to him) dealing with a pediatric patient that was on life support awaiting parents decision to withdrawn. Mother agreed, Translife was contacted and toward end of the day, father was contacted and agreed to organ donation also. Final statement on note says "He was taken to the OR where the ETT was removed and epinephrine infusion was discontinued. The fentanyl and midazolam drips were continued for comfort as requested by the mother, does of morphine and lorazepam were given as needed to assure comfort. He became pulseless at 1935 , and this was reconfirmed at 1943. Each time his monitor documented apnea and asystole. Time of death 1943." He wants to charge 99291 and +99292 for the time he spent with the patient throughout the day. I am thinking this should be a 99239 discharge summary charge per CMS. Can you give me any guidance when a case like this happens?
SuperCoder Answered Tue 06th of March, 2018 07:55:11 AM

Hi Pamela,

As per CMS: Critical care and other E/M services such as pronouncement of death provided to the same patient on the same date by the same physician can be billed, (assuming of course his documentation is extremely clear). You do need a modifier 25. Please see the below link for further clarity.

 http://assuming of course his documentation is extremely clear

Please feel free to ask for further query.


Pamela Posted Tue 06th of March, 2018 15:14:14 PM
This link does not open.
SuperCoder Answered Wed 07th of March, 2018 01:47:29 AM

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