Wiki Critical Care E&M

[philwjp]

If one of my doctors sees a patient in critical care for 60 min and another doctor in the same group sees the same patient for 90 minutes can the first doctor bill for 99291 and the 2nd doctor bill for 99292? I thought only one of them can bill for the total 150 minutes. They have the same tax id#.

 

[rthames052006]

No, the critical care should be billed under only 1 of the providers in the same group. You'd add the times together for both docs and bill accordingly.

The thing to decide is which doc gets the RVU's!

 

[kimberly514]

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."

 

[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