Billing For Critical Care After The Patient Is Deceased?

Can you bill critical care after the patient is dead? That's a question someone asked and used to find my site here at The Happy Hospitalist.  How could you possibly consider a dead person to be critically ill?  How could you possibly bill critical care for a patient that has already passed away?  On the date of discharge, Medicare allows the physicians to bill a discharge code CPT® 99238 for less than or equal to 30 minutes of work or a CPT® 99239 if the discharge work took greater than 30 minutes to complete.  Make sure to review the AMA's CPT 2018 Standard Edition as the definitive source on CPT® codes. Medicare does not recognize nor pay for any other evaluation and management codes on the day of discharge if billed for 99238 or a 99239.  Medicare does not allow billing a  hospital follow up visit (CPT® 99231-99233) then coming back later in the day if the patient is deemed stable for discharge and also billing  the discharge code.  Only the discharge code should be submitted.

What about critical care?   Medicare will pay you if you provide an E/M charge (such as admit or follow-up code) followed by a critical care code if documentation supports the need to come back later for a separate and identifiable face-to-face-encounter for critical care services.   This critical care time provided must be 30 minutes or more to bill CPT® 99291 and 75 minutes or more to add on the CPT® 99292 code as well.   Therefore, it's possible to submit an admit code 99223, a critical care code 99291 and an unlimited number of critical care 99292 add on codes in the same calendar day if you provided the work for 99223 before you provided the critical care work.

However, you cannot bill a critical care code first, and then bill an additional E/M charges (such as the 99223 or in the case here, a discharge code 99238 or 99239,  after the critical care time.  The only recognized code that can be billed after  work for a 99291 is provided, is the 99292 add on critical care code.  All work past the first 74 minutes of critical care time must be billed at 99292.

So where does that leave us in this situation were a reader is wondering if they can bill critical care for a  person has passed away?   If the patient you are evaluating rises to the level of critical care (which they will if they are dying and they aren't end of life/hospice) and you spend more than thirty or more minutes on the unit evaluating the data, talking with family and other hospital providers of care, you bill the  99291 code.  If they die during your evaluation you must continue your work in the post op period that includes providing a summary of the care and communicating your findings with others.  Can you bill for critical care now?  Of course not.  The patient is dead.

If you contact the family or contact the primary care doctor or dictate the discharge summary, you are providing necessary care at the bedside in the post mortem care of your patient, but there is no code other than the 99291 or 99292 that Medicare will recognize for services provided on the same calendar day after a 99291 service is provided.  Can't I bill critical care and a discharge code on the same date?  No.  See this link for details.  You shall provide your time for free.  That's right, you're giving your patient and their family and CMS a freeby because Medicare says this work is bundled into the pre and post critical care code.  I discussed that while reviewing how to bill a family meeting in the ICU.  CMS says:
Critical care CPT codes 99291 and 99292 include pre and post service work.
In this case, because the patient is dead and no longer critical, CMS is saying you do your work for free.

What if the  patient has already passed away and you show up to evaluate them?  Whatever you do, don't bill critical care.  That would be ridiculous.  You can, however, bill a discharge if  you declare them deceased, even if they passed away before you had a chance to see them alive.  For more information on E/M charges, visit my complete medical billing and coding lecture series on E/M coding. 


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