Physician must be face-to-face for Critical Care
During that 28 hours, you can only bill for the times the physician was at the bedside, face-to-face with the patient, providing critical care. This means that the ED doc is going to have to have recorded in/out times throughout the patient's stay in the facility.
The patient must be critically ill. AND the care provided must be face-to-face critical care of at least 30 minutes duration.
Once you cross past midnight, the clock starts over. So for a patient who came in at 11:20 pm on 01-10-11 and was finally transferred out at 03.20 am on 01-12-11 ... FOR ARGUMENT'S SAKE let's say ER physician provided direct critical care from 11:20 pm to 12:15 am on 01-11-11. ER physician also came in periodically for 10-15 minutes per visit over the next day ... let's say a total of 80 minutes critical care documented on 01-11-11. Then documented another 40 minutes of critical care on the morning of 01-12-11 before the patient was transferred out. For THIS SCENARIO you would code 99291 on 01-10-11, 99291 and 99292 on 01-11-11 and 99291 on 01-12-11.
Obviously you are going to have to deal with shift changes, so you need to make a decision on who gets to bill for the total time on 01-11-11, because you can bill out only under ONE ER doctor's name per day.
Hope that helps.
F Tessa Bartels, CPC, CEMC