Wiki Critical Care

[leachkristie@gmail.com]

An anesthesiologist bills critical care 99291 and then in the same day a critical care provider in the same practice sees the patient for a different primary reason but bills 99292. I have read everything stating it’s allowed if they are in same practice with same specialty, but they are different specialties. Should the add on visit be denied?

 

[chuckd1991]

I don't have experience with that one, but here's some info I found.

https://www.cgsmedicare.com/partb/pubs/news/2020/05/cope17364.html

• Different specialty:
  • Physicians of a different specialty may each report CPT code 99291 if they are providing care that is unique to his/her individual medical specialty and managing at least one of the patient's critical illness(es) or critical injury(ies)
• Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the initial critical care CPT code (99291). This service should be reported using another appropriate E/M code [ensuring all components of the CPT descriptor are met] such as subsequent hospital care.
• CPT code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care:
  • Reporting CPT code 99291 is a prerequisite to reporting CPT code 99292.
  • Includes "staff coverage" or "follow-up" even if a different specialty.
  • Must bill one unit for every 30 minutes (e.g., an additional 60 minutes would be 2 units).

 

[jkyles]

I don't have experience with that one, but here's some info I found.

https://www.cgsmedicare.com/partb/pubs/news/2020/05/cope17364.html

• Different specialty:
  • Physicians of a different specialty may each report CPT code 99291 if they are providing care that is unique to his/her individual medical specialty and managing at least one of the patient's critical illness(es) or critical injury(ies)
• Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the initial critical care CPT code (99291). This service should be reported using another appropriate E/M code [ensuring all components of the CPT descriptor are met] such as subsequent hospital care.
• CPT code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care:
  • Reporting CPT code 99291 is a prerequisite to reporting CPT code 99292.
  • Includes "staff coverage" or "follow-up" even if a different specialty.
  • Must bill one unit for every 30 minutes (e.g., an additional 60 minutes would be 2 units).

This is correct. The intensivist should report the primary code if their work meets all of the requirements for critical care. An add-on code alone would be denied.