Wiki ndrummond

[ndrummond]

I have an ICU provider that is trying to bill for critical care and prolonged care. Can he do this? When I research billing for prolonged care in the inpatient setting, it shows it being billed in addition to "regular" E/M services and gives examples of billing it with initial and subsequent daily care. However, I can't find any documentation that specifically states that prolonged care cannot be billed with critical care. Can anyone help me with this?

 

[mhstrauss]

I have an ICU provider that is trying to bill for critical care and prolonged care. Can he do this? When I research billing for prolonged care in the inpatient setting, it shows it being billed in addition to "regular" E/M services and gives examples of billing it with initial and subsequent daily care. However, I can't find any documentation that specifically states that prolonged care cannot be billed with critical care. Can anyone help me with this?

I'm assuming you are referring to the Prolonged Services codeset 99354-99357. If so, there are a list of approved "parent codes" that the prolonged codes should be added to, directly beneath each prolonged service code in the CPT book. Crit Care codes 99291 and 99292 are not included in the list. Your provider should be using multiple units of 99292, along with the primary 99291 of course, to get to the total time that he spent in Crit Care with the patient for that DOS.

Hope this helps!