Pulmonology Coding Alert

Question: May two physicians from the same specialty charge for critical care on the same day for the same patient? Would this fall under concurrent care?

Florida Subscriber

Answer: Don't be too quick to bill concurrent care for critical care services. Although two physicians from the same specialty can qualify for concurrent care in limited situations, these rules do not apply to critical care services. The circumstances of the physicians'services will help you decide whether you can bill for critical care for both physicians.

Three rules may help you understand when two physicians should bill for critical care on the same day:

1. The physicians must be of different specialties or subspecialties.

2. They have to use two different primary ICD-9 codes.

3. They must bill for critical care during different time periods.

Multiple physicians from the same practice may report critical care services if the cumulative time for each physician equals at least 30 minutes. You need to report all services together, however, and bill under one physician in the group, usually the physician who provided the initial 99291 service (Critical care, evaluation and management).

For example, Dr. Aperforms 35 minutes of critical care services on a patient with emphysema at 10 a.m. Later that day, Dr. B, from the same specialty, performs 30 minutes of critical care on the same patient. In this case, you would bill 99291 under Dr. A's personal identification number. Also, remember that Medicare will not pay for more than one physician reporting critical care services in any given hour.