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Critical Care Coding Questions

Tonyj

True Blue
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Physician A bills a critical care code.
Physician B bills an E/M hospital initial or subsequent code for the same patient and the same day. Is this billable by both MD's?

It is understood that rounding in the CC unit and billing a subsequent hospital care code is feasible as long as it in not related to an operative procedure (non-global care)but can 2 physicians from the same group bill on the same day for the separate services?
 

klittle72

New
Messages
6
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Physician A bills a critical care code.
Physician B bills an E/M hospital initial or subsequent code for the same patient and the same day. Is this billable by both MD's?

It is understood that rounding in the CC unit and billing a subsequent hospital care code is feasible as long as it in not related to an operative procedure (non-global care)but can 2 physicians from the same group bill on the same day for the separate services?
In the Medicare Claims Manual, it says
When a hospital inpatient or office/outpatient evaluation and management service (E/M) are furnished on a calendar date at which time the patient does not require critical care and the patient subsequently requires critical care both the critical Care Services (CPT codes 99291 and 99292) and the previous E/M service may be paid on the same date of service.

So you can bill a subsequent hospital care code, and later bill critical care if it becomes necessary, but not critical care followed by regular rounding visits by the same specialty.
 
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Specialist billing for ICU services while they primary also bills for ICU services.

My provider is a Pediatric Infectious Disease specialist and she sees patients in the NICU or PICU to find the infectious diseases she was asked to consult by the primary physician. She bills for ICU services because she provides the services that are outlined in these ICU codes. She has taken responsibility of the childs health until she finds the infection. Her claims are getting denied because the Primary Provider billed for these services so now our claim is deemed "code billed by another provider". Any suggestions on what code we should use other than a 99233? This level is too low for all the service and documentation she provides.
 
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