billing 99291 & 99292, provided by different doctors, same specialty, same practice

eutsler

Networker
Messages
38
Best answers
0
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.
 

amsmith

Networker
Messages
94
Location
Yucaipa, CA
Best answers
0
They should be billed as one physician with both sets of time added together under one physician.

2010-ACCP When more than one member of the same group and specialty provides services meeting critical care requirements to the same patient of the same calendar day, all of the critical care services should be reported under one provider number. Using the "total time" method for documentation allows easy calculation of the all the critical care time provided by both physicians.
Section 30.6.12E Physicians in the same group practice who have the same specialty may not each report CPT initial critical care code 99291 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.
 
Top