CMS reminds providers to bundle emergency visit services with critical care

Wednesday, October 28, 2020

Physician and non-physician practitioners may benefit from reviewing bundling rules for emergency department visit services billed on the same date as critical care, according to the October 2020 Medicare Quarterly Compliance Newsletter.

The newsletter reminds providers that hospital emergency department visits are not payable when they are performed on the same calendar date as critical care services, when billed for the same beneficiary on the same date of service and by the same provider.

Medicare Recovery Auditor Contractors may recoup payment for emergency department E/M codes 99281-99285 when billed for the same beneficiary, on the same date of service as CPT code 99291 (critical care, E/M of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( …; each additional 30 minutes).

If a patient requires critical care services upon presentation to the hospital emergency department, the provider may only report critical care code 99291, and in some cases, add-on code 99292. He or she may not report an emergency department visit code.

Additional information on billing and payment for emergency department visits rendered on the same day as critical care is available in the Medicare Claims Processing Manual.

Editor's Note: This article originally appeared in Revenue Cycle Advisor.