How would the following scenario be coded:
Dr. A spent 30 Critical Care minutes at 2:30 pm
Dr. B spent 34 Critical Care minutes at 4:45 pm
Dr. C spent 45 Critical Care minutes at 7:37 pm
How would the following scenario be coded:
Dr. A spent 30 Critical Care minutes at 2:30 pm
NP. B spent 34 Critical Care minutes at 4:45 pm
Dr. C spent 45 Critical Care minutes at 7:37 pm
Providers must be billed separately to accurately capture the work they performed.
Thank you, I appreciate your help.
Madeline Murphy
First the reason there is an issue. APPs (PA and NP) are reimbursed at a different rate. This leaves the question about how to combine time. Another issue is the specialty code that is used. Since there is only one code for NPs (50) and PAs (97) this will be different from the physicians and not obvious that they are the same specialty. This has lead to different rules depending on the MAC.
Here is Noridian guidance:
https://community.corporatecomplian...tFileKey=a56315f9-9706-4402-b47a-a00e81334e07
Page 45 details APP and MD documentation
Dr. Brown, a cardiologist
– Performs 40 minutes of critical care
• NPP same group
– Performs 35 minutes of critical care
• Billing
– 99291 under the MD’s NPI
– 99291 under the NPP’s NPI
• Note: Staff coverage or follow up after the
first hour a NPP may bill the 99292
So according to this the NP B would bill a 99291
Dr A would bill a 99291 and Dr C would bill a 99292
Or if it was all considered follow on care and they are treated as one physician:
Dr A Would bill a 99291
NP Bs time would be added to the 99291
Dr Cs time would be added to the 99291 and then bill 2 x 99292 (31 minutes)
Now in our shop we would bill according to our MAC instructions used to be Cahaba now Palmetto
Add the total time by like providers (MD and APP) then divide the time based on 99291-92. When different providers have time in the same slot the provider with most minutes gets the bill.
In this case Drs A and C billed 75 minutes so bill a 99291
NP B has 34 minutes which would be 29 minutes (add one minute from Dr C) for a 99292 and an additional 99292 for the remaining 5 minutes.
Finally if that's not confusing enough there are a number of coders that go off the CPT which states only one provider can bill the 99291. So if the initial provider meets the measure all the additional time is 99292. I this case it would look like this:
Dr A 99291
NP B 99292
Dr C 99292 x 2 (45 minutes + 4 minutes from NP B)