Critical Care 99291/99292 same day diff doc

bill2doc

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I should know this answer and I thought I did but there seems to be confusion in our office.

Our doc was called to a patient in respitory failure. Our doc is a critical care/pulmonary doc and spent 80 min with the patient. All documentation supports (illness that acutely impairs one or more vital organ systems such that there is a high probability of imminenet or life threatening deterioration) critical care.

A different doctor, different group different office - don't even know this doctor - submitted a bill for the same date for critical care as well. 99291

I thought that if the doctors were different groups, completely seperate from each other that both docs could get paid for the critical care....???

Carrier (kaiser) originally paid us but are now requested the funds back because they paid the other doctor instead.

Please help me with this...thank you
 

btadlock1

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Lubbock, TX
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I should know this answer and I thought I did but there seems to be confusion in our office.

Our doc was called to a patient in respitory failure. Our doc is a critical care/pulmonary doc and spent 80 min with the patient. All documentation supports (illness that acutely impairs one or more vital organ systems such that there is a high probability of imminenet or life threatening deterioration) critical care.

A different doctor, different group different office - don't even know this doctor - submitted a bill for the same date for critical care as well. 99291

I thought that if the doctors were different groups, completely seperate from each other that both docs could get paid for the critical care....???

Carrier (kaiser) originally paid us but are now requested the funds back because they paid the other doctor instead.

Please help me with this...thank you
If you can show that your provider and the other provider performed critical care services at different times, and that your provider's service was medically necessary, you should be able to have the recoupment request overturned. I'd appeal with records. Hope that helps! ;)
 
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