Part B Insider (Multispecialty) Coding Alert

Published on Tue May 24, 2005 PDF

With many hospitals hiring critical care teams to handle critical cases,  physicians are finding themselves elbowed aside when their patient reaches a crisis point.

No two physicians can bill for critical care during the same hour, notes Jennie Horner, a coder with Southern Ohio Medical Center in Portsmouth, OH. If a physician starts out treating a critical patient for the first hour, and then a critical care team takes over, the first physician can bill for the period before the team took over, Horner notes. "It's doable if it's documented."

"Some physicians have a little trouble understanding that even if a patient is in critical condition you still may not be providing critical care," Horner adds. If someone else is in charge of critical care, then the primary care physician can still bill a higher level Evaluation and Management code for caring for the critical patient.

In practice, whoever bills first will receive payment for critical care, Horner notes. "That's fine until you hit an audit," she adds.

Also, if two physicians from the same specialty and group provide critical care on the same date but at different times, you should only bill under the provider number of the physician who provided the most care, notes Sharon Tucker, a consultant with Seminars Plus in Fountain Valley, CA. For example, if a pulmonologist provides an hour and a half of critical care to a patient in the morning and then a second pulmonologist provides an hour in the afternoon, you'd bill under the first pulmonologist's number.