Pulmonology Coding Alert

Reader Questions:

Avoid 2 Pulmonologist Reporting Same-Day Critical Care

Question:A pulmonologist in our practice saw a patient in the morning for critical care. In the evening, a second pulmonologist saw the same patient. I heard the correct way to code this scenario would be to add the minutes together and use only one physician. Is it so, or do I bill critical care for both doctors separately?Rhode Island SubscriberAnswer:According to Section 30.6.12E of the Medicare Claims Processing Manual, physicians in the same group practice who have the same specialty may not each report CPT initial critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) for critical care services to the same patient on the same calendar date. Medicare payment policy states that physicians in the same group practice who are in the same specialty must bill and be paid as though each were the single physician. Option: Medicare [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Pulmonology Coding Alert

View All