Wiki Critical care change 2013

[donnaber]

Hi:
Can someone please help with changes to critical care that took place effective April 1, 2013? In the following scenario how would you code and bill for physician initial critical care service followed by nurse practitioner/PA critical care service?
It is my understanding that for Medicare prior to 2013, CPT code 99292 could only be billed by same provider as CPT code 99291 since 99292 is an add on code. Prior to 2013 we would have billed all the critical care time (both physician and NP/PA) under the physician who performed the initial care.
After April 1, 2013 for Medicare purposes we would code and bill forwhoever performed the service; ie the physician who performed initial critical care would code and bill 99291; NP/PA would code and bill 99292.

Am I correct in my understanding, and can you point me to any guidance that validates this change in coding and billing.

Thanks so much!

 

[catrinaquin]

No, if the PA or NP is part of the same group as the doctor, then you need to combine the critical time or minutes and bill under the provider who has the most time. Keep in mind, the PA or NP need to be credential and have their own NPI #.If their combined time is less than 74 minutes, you would bill 99291only. If their combined time is more than 74 minutes, you will then bill 99291 and 99292 accordingly. If any of them perform procedures on the same day as critical care, then you would add a modifier-25 to the critical care codes. Here is a helpful link:
http://www.sccm.org/Communications/...Billing-Basics-Billing-for-Critical-Care.aspx

 

[Chappy10]

catrinamq@gmail.com - I would have to disagree and your attached document does not support your answer either.

Of course the times were not given in the question which would be important, but assuming everything is met - CC requirements, medical necessity and times.

For example - 1st provider - Dr. A spent 45 minutes providing CC services, then the other provider - NP. B (as long as in their state scope of care) spent another 45 minutes in CC time. Total CC time of 90 minutes (assuming not performed at same time - each should show times they provided in these cases as it cannot overlap).

donnaber - you are correct based upon that CMS transmittal referenced (assuming it is a payer that allows)

Dr. A 99291
NP B 99292

(This is a payer rule as it goes against the CPT add on definition, but is allowed as it is very often appropriate - thus the change. Check your payer rules to be sure. If not, it should still not all be aggregated and billed under the one physician unless that physician is meeting the minimum time requirement to bill both 99291 and 99292 of 75 minutes since it is not allowed to be split/shared is essentially what it sounds like was being done previously - donnaber

Any other thoughts?

Also curious - Anyone having MAC contradictions with CMS transmittal 2636?