ED Coding and Reimbursement Alert

Question: A critically ill patient was seen by one emergency physician who documented 91 minutes of critical care time. Later that afternoon, a second emergency physician was asked to see the patient for hypotension, started a central line and documented 60 minutes of critical care time of his own. Do I add the critical care services together for the first physician and give the second physician credit for the procedure, or should I just report everything under the second physician?

Maryland Subscriber

Answer: Two physicians of the same specialty in the same group will be deemed to be the same provider for Medicare critical care billing purposes when treating the same patient on the same day. In this scenario, you would add the critical care time together for 151 minutes, assuming there is a statement indicating the reported times not include placing the central line. Since the procedure was performed by the second physician, it makes more sense to report the procedure under his NPI number. The provider who delivered the majority of the critical care would typically be chosen for reporting the critical care service.

On the claim(s) report: 99291 (Critical care, evaluation and management, of the critically ill, or critically injured patient, first 30-74 minutes) for the first hour of critical care and three units of 99292 (...each additional 30 minutes) and because it is not bundled into critical care, 36556 (Insertion of non-tunneled centrally inserted venous catheter, age 5 years or older).