Question PA and Physician/Inpt subsequent visit/Critical Care

Messages
5
Best answers
0
If a PA and a Physician both see an inpatient (subsequent visit), the PA performs and documents HPI, Exam and Assessment and Plan. Then the physician sees the patient and adds an addendum to the PA’s note that he also performed and documented an exam, viewed labs, images, reviewed the PA’s documentation and agree with the findings and treatment plan as documented by the PA. Does this allow for the Physician to bill the subsequent visit?
Basically the same as above but regarding Critical Care. Can the physician add an addendum to a CRNP/PA’s documentation stating that he examined the patient and reviewed labs, imaging, etc and agree with the assessment and plan and then bill the CC charge? Again, can the physician add an addendum to the PA’s note and bill the visit?
 
Messages
249
Location
Coeur d'Alene, Idaho
Best answers
1
No, critical care services do not fall under the split/share rules. Per CMS:
A split/shared E/M service performed by a physician and a qualified NPP of the same group practice (or employed by the same employer) cannot be reported as a critical care service. Critical care services are reflective of the care and management of a critically ill or critically injured patient by an individual physician or qualified non-physician practitioner for the specified reportable period of time.
Unlike other E/M services where a split/shared service is allowed the critical care service reported shall reflect the evaluation, treatment and management of a patient by an individual physician or qualified non-
physician practitioner and shall not be representative of a combined service between a physician and a qualified NPP.
When CPT code time requirements for both 99291 and 99292 and critical care criteria are met for a medically necessary visit by a qualified NPP the service shall be billed using the appropriate individual NPI number. Medically necessary visit(s) that do not meet these requirements shall be reported as subsequent hospital care services.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1548CP.pdf
 
Messages
5
Best answers
0
No, critical care services do not fall under the split/share rules. Per CMS:
A split/shared E/M service performed by a physician and a qualified NPP of the same group practice (or employed by the same employer) cannot be reported as a critical care service. Critical care services are reflective of the care and management of a critically ill or critically injured patient by an individual physician or qualified non-physician practitioner for the specified reportable period of time.
Unlike other E/M services where a split/shared service is allowed the critical care service reported shall reflect the evaluation, treatment and management of a patient by an individual physician or qualified non-
physician practitioner and shall not be representative of a combined service between a physician and a qualified NPP.
When CPT code time requirements for both 99291 and 99292 and critical care criteria are met for a medically necessary visit by a qualified NPP the service shall be billed using the appropriate individual NPI number. Medically necessary visit(s) that do not meet these requirements shall be reported as subsequent hospital care services.


https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1548CP.pdf
Thank you! I am not familiar with Critical Care coding.
 

bill2doc

Expert
Messages
399
Best answers
0
@AmandaBriggs, I'd love to be able to pick your brain regarding NP Critical Care billing. Things are changing at our hospital and I need someone with experience to answer some questions for me. Would you be willing to talk by phone or private email. Thanks so much in advance
 
Top