Crisgo88
Guest
I have something completely different and can't find guidelines. A NP sees and performs Critical Care services, documentation is completed. Then the physician comes by and sees the patient and adds the following attestation to the NP's note.
"I examined the patient at the bedside with the critical care team, including the person that wrote this note. We reviewed all laboratory data, radiologic studies, and discussed the past and future treatment plan. Additionally, I reviewed the findings and assessment/plan outlines in this note and agree, with any exceptions and/or additions noted. I personally spent >30 minutes guiding care."
#1 I checked with the NP and she was not in the room with the physician
#2 The physician bill 99291 and the NP bills 99292 for time over 74 minutes even though she saw the patient prior to the physician. OR 99291 is only billed under the physician if he claims 35 minutes and the NP claims 35 minutes.
#3 I don't know who comprises the Critical Care Team
#4 The same thing is done on subsequent visits.
#5 There is a resident present with the physician on the majority of the encounters. I know the time spent teaching the resident can't be included.
#6 On occasion, there is an additional statement by the physician that states why the patient requires Critical Care and reiterates continuing specific orders.
#7 I'm concerned about the "guiding care" statement instead of "Providing Critical Care".
Can anyone lead me to guidelines that state each provider must document their own progress note for Critical Care or any other issues I'm not comfortable with?
"I examined the patient at the bedside with the critical care team, including the person that wrote this note. We reviewed all laboratory data, radiologic studies, and discussed the past and future treatment plan. Additionally, I reviewed the findings and assessment/plan outlines in this note and agree, with any exceptions and/or additions noted. I personally spent >30 minutes guiding care."
#1 I checked with the NP and she was not in the room with the physician
#2 The physician bill 99291 and the NP bills 99292 for time over 74 minutes even though she saw the patient prior to the physician. OR 99291 is only billed under the physician if he claims 35 minutes and the NP claims 35 minutes.
#3 I don't know who comprises the Critical Care Team
#4 The same thing is done on subsequent visits.
#5 There is a resident present with the physician on the majority of the encounters. I know the time spent teaching the resident can't be included.
#6 On occasion, there is an additional statement by the physician that states why the patient requires Critical Care and reiterates continuing specific orders.
#7 I'm concerned about the "guiding care" statement instead of "Providing Critical Care".
Can anyone lead me to guidelines that state each provider must document their own progress note for Critical Care or any other issues I'm not comfortable with?