Wiki Critical Care Visits

[TMB1965]

If a critical care hospitalist group has mid-levels seeing the patient, and they do an addendum on their note stating they saw the patient as well and provided critical care services with the time documented do you bill an Initial Hospital Visit or Subsequent Visit since you can't report Critical Care Split/Shared visits? Also if the MD just signs their note or doesn't do a proper addendum then can you bill Critical Care for the Mid-Levels?

 

[dmunoz781]

Hello

If a true critical care service is provided on the same day by same specialty, on the day of admission then only the critical care services is billable and not the initial hospital/subsequent code. If more than one critical care service has been provided by the same group on the same day then times can be combined to add appropriate 99292 to the initial 99291. If by midlevels you mean PA or NP then yes they can bill for the 99291- 99292 if that is the service that they provided check out this link, it states that qualified physicians and NPP (PA and NPS) can bill the service.

Because midlevels such as PAs and Nurse Practitioners are NPP they can bill for services provided without the supervision of an attending MD. When submitting the claim without an appropriate attestation statement the PA or NP will be places as the service and billing provider and get reimbursed at a different rate than if the MD attended.

For residence if they provide a service without and attending around and without an appropriate attestation statement then the service is not billable as they cannot perform services without the supervision of an MD.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2997CP.pdf

I code out of California and for some reason have vague recollection of CC being a service that NPs cannot bill for under CA Medi-cal, they set additional regulations apart from that of Medicare. I cannot find anything on that matter but CMS should have not issue.

Sorry it was so long winded. Hope it helps.