DOS for overlapping dates

Hello,

If a service (Whether it be a surgery or critical care) is started on one day (e.g. starts at 11:45 p.m.) and finishes the next do you use the start date or end date as the DOS? Any links to official resources would be much appreciated! I feel like I had found the answer to this a couple years ago but I can't find it now.

Thanks!

Comments

  • edited June 2017
    I bill surgeries - I always use the date when the surgery started.



    Thanks

    Deborah Broyles, CPC
    Supervisor/Coding Specialist
    University Radiation Oncology/University Surgical Oncology
    865-305-9886 phone / 865-305-9714 Fax

    Notice & Disclaimer:  The information given in this email is intended as generalized coding guidance and should not be misinterpreted as medical, health, legal or financial advice. Furthermore, it is the responsibility of the provider to code services as they are documented in the permanent medical record following federal and state regulations, as well as carrier specific guidelines. Any information given should not be modified in any way, sold for profit or shared without the express permission of UPA. While all information given is thoroughly researched and believed to be correct, recipients of this email accept responsibility for their own coding and documentation.

  • Found my answer.

    From NGS Medicare:
    What is the correct way to report critical care when the continuous critical care time crosses midnight into the next calendar date? Example: 120 minutes of critical care, start time 11:00 pm on day 1 and continuing into day 2 from 12:00 am until 1:00 am.

    Answer: These services would be appropriately billed as one unit of CPT 99291 (first hour) and two units of 99292 (2 increments of additional ½ hours), all billed on the initial DOS. As a reminder, billing for these services requires performance by an attending physician or hospitalist; services by residents are not billable to Medicare.
    https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/policy-education/evaluation and management/evaluation and management frequently asked questions/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOJNHD1dDQ2dDbz9LTwMDBy9XRxNHP3cjd1NjPWDU_P0C7IdFQGsY8dp/#14


    “FAQ 4. If the critical care codes address services provided on a single date, what happens if the critical care service extends into another calendar day?

    CPT coding principles require that when a time-dependent service is performed continuously and crosses over midnight the time should be accrued for, and reported as occurring, on the pre-midnight date. However, once the service is disrupted (i.e., becomes non-continuous), then that creates the need for a new initial service on the post-midnight date. The following examples for critical care are constructed for better contrast, but the coding effects would be similar even if the respective times were hours distant from midnight:

    Scenario 1: How would you code a patient who presents to the ED at 2335 Day 1, with CC services beginning at that time and performed continuously until 0015 on Day 2, with no more CC services performed on Day 2?
    Answer: Critical care 99291 can be reported for Day 1.

    Scenario 2: How would you code a patient who presents to the ED at 2335 Day 1, with CC services beginning at that time and performed continuously until 0015 on Day 2, at which time continuous CC services are interrupted; CC services are reinitiated at 0030 Day 2, with an additional 65 minutes provided on Day 2 following the re-initiation?
    Answer: Critical care 99291 can be reported for Day 1, and a second 99291 reported for Day 2.

    Be sure documentation demonstrates the relevant circumstances.”

    Resource: https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Critical-Care-FAQ/



    “HOW IS CRITICAL CARE TIME AGGREGATED WHEN THE VISIT CROSSES THE MIDNIGHT HOUR?

    For critical care services that cross the midnight hour and meet the 30 minute threshold, payment for CPT® 99291 should be submitted on the calendar date when the face-to-face encounter began. If evaluation becomes non-continuous after the midnight hour and subsequent critical care service is provided, an additional CPT ®99291 should be considered if the 30 minute threshold is again achieved. For example, if you are a hospitalist and you take care of a direct admit by providing continuous critical care service from January 1st 11:45 pm to January 2nd at 12:20 am and provide no more critical care on January 2nd, you should submit payment for CPT® 99291 on January 1st. However, if you leave the ICU and go take care of another patient from 12:20 am to 12:30 am and then get called back to provide critical care services from 12:30 am on January 2nd to 1:05 am on January 2nd, you should also submit an additional payment for CPT ® 99291 on January 2nd.”

    Resource: http://thehappyhospitalist.blogspot.com/2008/11/how-to-bill-critical-care.html
  • edited June 2017
    It is also in Introduction from the front of the CPT book under the heading TIME.

    Also CPT Assistant 2011

    Reporting time across calendar dates
    Some services measured in units other than days extend across calendar dates. To aid in the understanding of appropriate reporting of time across calendar dates, consider the following:

    Was a continuous service provided?
    If a continuous service was provided, report all units as performed on the date the service started. For continuous services that last beyond midnight, use the date on which the service began and report the total units of time provided continuously. For example, if intravenous hydration as described by codes 96360 and 96361 is given from 11:00 pm to 2:00 am, code 96360 would be reported once for the first hour and code 96361 would be reported twice (once for each additional hour of hydration intravenous infusion).

    Was the service discontinuous?
    Any disruption in service creates a new initial service. For example, a patient receives one hour-long drug infusions at 10:00 pm and 2:00 am on sequential dates. No new IV is started and the same drug is infused each time. In this example, because the infusion is not a continuous service, code 96365 would be reported once for each date of service.



    TT


    Todd Thomas, CPC, CCS-P ERcoder, Inc
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