99291/99292, 2 physicians same practice

adi

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Looking for clarification, please advice how your practice is handling below scenerio. Thanks in advance. adiaz

Can you please help me clarify latest Critical Care - Med Learn article, especially page 9 of 15, last bullet and page 10 of 15 top bullet and example a) - http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5993.pdf

Dr. X and Dr. Y are in the same pulmonary practice and see the same pt on the same day -

Dr. X renders initial Critical Care, documentation supports - 99291, total time documented = 40 minutes.
Later on the same day, Dr. Y is called to see patient and renders Critical Care services, documents 70 minutes.
Total Critical Care time for day = 110 minutes

According to MedLearn article, how should service be billed since physician X and Y are in the same practice?

A) Dr. X will receive credit for total CC time (110) rendered for day = 99291 x 1 and 99292 x 2

B) Dr. X will receive credit for 40 minutes = 99291 and
Dr. Y will receive credit for 70 minutes = 99292 x 2

If scenerio B is submitted, will an edit be generated due to code 99292 being an "add on" code only that requires code 99291 to be submitted.
 

ruacoder

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critical care same group

most likely the claim will edit for request of notes either way. Dr X time will need to have notes sent for Medicare reveiws all critical care charges for medical necessity.

Along with that claim I would suggest sending in the Dr Y notes in addition to the notes for Dr X.

When credentialing these providers the "group" NPI # should be the same, and upon payment of the 99291 Dr X, inital service code, calling the ARU with the HIC # for that paid claim, will help to appeal the 99292 to be paid as well, as the 99291 is the "qualifying code" for the add on code 99292.

Medicare requires that these notes be faxed in ahead of time for those who are submitting electronic claims.
 

rjconnell

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Actually, I bill this quite frequently as my physicians are critical care intensivists. All time is added together and submitted under one provider name. The question then becomes which provider name, who gets the RVUs? In my practice we go with whoever saw them first on that calendar day so that the physician that got called in the wee hours of the morning gets the credit. Another ICU in my hospital bills under the provider that provided the most time. Medicare has not been routinely requesting notes, that may be because of our specialty.
 

adi

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Thanks to all who replied. I appreciate your feedback. Based on further review of MedLearn article and comments, I am going to stick with our current practice of submitting claim under scenario A. Have a great day. adiaz
 
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