eutsler
Networker
billing 99291 & 99292, provided by different doctors, same specialty, same practice
A critically ill patient is seen by Dr. A, who is a pulmonologist. The critical care time is 55 minutes.
Later in the day the patient decompensates and is seen by Dr. B, a pulmonologist from the same practice as Dr. A. The critical care time is 35 minutes. Neither Dr. A nor Dr. B performed any separately billable procedures.
99292 is being denied, the reason for the denial is "the benefit for this service is included in the payment/allowance for another procedure that has already been adjudicated. Add-on code cannot be billed by itself."
Noridian held a webinar recently, but did not make clear how to submit 99292. They gave an example of two physicians, same practice, different specialties in which Dr. Pulmonologist spends 45 minutes on critical care and Dr. Cardiologist later spends 40 minutes on critical care; they state Dr. Cardiologist "could bill a 99291 or 99292 • As long as the services are not duplicative • Not a covering or staffing physician".
The claims in question are First Coast, not Noridian; but the same thing is happening with non-Medicare claims.
Do both charges need to be submitted under physician A so they'll be on the same claim? If so, I can let the AR team know they need to set up some sort of crosswalk so everyone gets credit for work done.
A critically ill patient is seen by Dr. A, who is a pulmonologist. The critical care time is 55 minutes.
Later in the day the patient decompensates and is seen by Dr. B, a pulmonologist from the same practice as Dr. A. The critical care time is 35 minutes. Neither Dr. A nor Dr. B performed any separately billable procedures.
99292 is being denied, the reason for the denial is "the benefit for this service is included in the payment/allowance for another procedure that has already been adjudicated. Add-on code cannot be billed by itself."
Noridian held a webinar recently, but did not make clear how to submit 99292. They gave an example of two physicians, same practice, different specialties in which Dr. Pulmonologist spends 45 minutes on critical care and Dr. Cardiologist later spends 40 minutes on critical care; they state Dr. Cardiologist "could bill a 99291 or 99292 • As long as the services are not duplicative • Not a covering or staffing physician".
The claims in question are First Coast, not Noridian; but the same thing is happening with non-Medicare claims.
Do both charges need to be submitted under physician A so they'll be on the same claim? If so, I can let the AR team know they need to set up some sort of crosswalk so everyone gets credit for work done.