Wiki Critical Care Denials

Can someone please help me out with Critical care codes, please. I work for a Pulmonary group and we are getting denials for our critical care codes. If one provider provides critical care for 45 mins. and another provider from the same group provides critical care to the same patient on the same day for 35 mins, can we add up the time as a total of 80 mins. of Critical time and bill 99291x1, and 99292x2? If so, do both the CPT codes have to be on the same claim and under one provider's name? Any help/advice on this would be greatly appreciated! Thank you so much

Hi
I need more information to work on denial ....what are the dx code using? What does the documentation say?
Lady T

Thank you so much for getting back to me. I am working on sending you more details ASAP.
However, I am confused about the time criteria for 99291 and 99292. Can you only bill 99292 when you have an additional 30 minutes on top of 74 minutes? Do you have to have 104 minutes of total critical care time in order to bill 99291 and 99292?

CPT and Medicare have different rules for reporting Critical care code 99292 for CY 2023. MC requires the full 30 minute block of 99292 to be reached before billing it. Also, I believe that the billing of 2 providers in the scenario you mentioned, is payer specific. I know my insurance company would kick it out because its and add-on procedure without the proper initial service code billed by the same provider on the same date of service. However, you may be able to send records or contact a provider rep to get it pushed through manually.