Wiki Critical Care billing

[cherarch@gmail.com]

Those of you who do Critical Care coding, how are you coding claims when more than one intensivist see the patient during the 24 hour period?

Are you coding 99291 for the first doctor and then combining the time for the rest under 99292?

Examples please.

Thank you

 

[Pam Warren]

No, we combine all the time and bill under the first provider who saw the patient that calendar day. If you bill the second code under a different provider without the first parent code, you'll get a denial.

 

[cherarch@gmail.com]

Hey Pam,

Thank you for the response. We had been coding that way for years, but our coding dept came thru and said we had to bill under each provider so they would "get credit". It is causing huge headaches and lost revenue.

 

[Pam Warren]

I know what you mean about "getting credit". I tell them that either they get credit or we get paid! They decided it was better to get paid.

 

[kimberly514]

Per Medicare Transmittal 2636
Date: January 16, 2013

"The Internet Only Manual, Claims Processing Manual, Publication 100-04, Chapter 12, Section 30.6.12(I) requires a provider to report CPT code 99292 (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)) without its primary code CPT code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) if two or more physicians of the same specialty in a group practice provide critical care services to the same patient on the same date of service. For the same date of service only one physician of the same specialty in the group practice may report CPT code 99291 with or without CPT code 99292, and the other physician(s) must report their critical care services with CPT code 99292."

 

[MarcusM]

It is most important to get paid for everyone's work. Split the reimbursement based on the time spent by provider....usually it all works out in the end.

 

[RebeccaCross*]

Palmetto GBA example

Jurisdiction 11 Part B
E/M Weekly Tip: Critical Care Billing Same Specialty/Group

If a provider in the same specialty/group provides 'staff coverage' or 'follow-up' for each other after the first hour of critical care services was provided (same calendar date), the subsequent visits by the 'covering' provider in the group must be billed using CPT critical care add-on code 99292. The appropriate individual NPI number must be reported on the claim.

Example:

Drs. Smith and Jones, pulmonary specialists, share a group practice. On Tuesday Dr. Smith provides critical care services to Mrs. Benson who is comatose and has been in the intensive care unit for four days following a motor vehicle accident. She has multiple organ dysfunction including cerebral hematoma, flail chest and pulmonary contusion. Later on the same calendar date, Dr. Jones covers for Dr. Smith and provides critical care services. Medically necessary critical care services provided at the different time periods may be reported by both Drs. Smith and Jones. Dr. Smith would report CPT code 99291 for the initial visit and Dr. Jones, as part of the same group practice would report CPT code 99292 on the same calendar date if the appropriate time requirements are met.

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction-11-Part-B~9B9K684470

 

[Ryannwoike]

I have a question, what if the first visit of the day is recorded by the PA in the ICU before the Attending comes in for the day? does the PA get the initial, and the MD get the additional when he sees the patient?