Wiki 99291 and 99292 coding

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dchase58

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How would you code the services of two different physicians from the same practice, both provided critical care, during the same date of service for a patient?
Provider 1 provided 75 minutes of care 99291
Provider 2 provided the addition 60 minutes of care at a different time during that same date. 99292 X 2?
Would these be reported on the same claim form if they bill under a GPN or can it be billed on 2 separate claim forms even though 99292 is an add on code?
 
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Since all of the providers in the group are considered the same entity you will have to choose one provider and bill all of the services under them.

I usually select whoever's visit is longer, so I would bill under the first provider: 99291, 99292 X 3 (since the total time is 135 minutes)
 
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Per the ICD-10 Monitor article, "Understanding the Key Elements of Critical Care Coding," by Terry Fletcher who is recognized as an expert in our industry:

  • Same-specialty physicians (i.e., two hospitalists from the same group practice) may require separate claims. The initial critical care hour (99291) must be logged by a single physician. Medically necessary critical care time beyond the first hour (99292) may be met individually by the same physician or collectively with another physician from the same group. The physician performing the additional time beyond the first hour reports the appropriate units of 99292 under the corresponding NPI. It’s the only add-on code in CPT that is allowed to be billed alone to Medicare, without a base code first.
  • CMS has issued instructions for contractors to recognize this atypical reporting method. However, non-Medicare payors may not recognize this newer reporting method and maintain that the cumulative service (by the same-specialty physician, in the same provider group) should be reported under one physician name. Be sure to query the payors for appropriate reporting methods
This article contains some really great information. Here is a link to it:
https://www.icd10monitor.com/understanding-the-key-elements-of-critical-care-coding
 
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