Wiki Split/Share visit critical care

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kalpana

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Split/shared visits do not apply to consultations (99241-99255),critical care services (99291-99292)!!
Can we down code Cpt 99291 to 99233 !
Is there any documentation available on this!
Please advise.
Thank You,
Kalpana Ananth
 
You may code a subsequent care visit as long as the documentation supports it. Per the Medicare Claims Processing Manual (link here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf ):

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.
 
kalpana said:
Split/shared visits do not apply to consultations (99241-99255),critical care services (99291-99292)!!
Can we down code Cpt 99291 to 99233 !
Is there any documentation available on this!
Please advise.
Thank You,
Kalpana Ananth
Click to expand...
Medicare doesn't reimburse for consults any more and very few private payers pay for them. Most of the time you crosswalk these to initial care codes.

The other question is why would you down code a 99291? You can bill it under the APP and get 85% of the physician value. A 99233 reimburses 2 wRVUs or around $64 at Medicare rates. A 99291 reimburses 4.5 wRVUs or around $144 at Medicare rates. Even with the 85% reimbursement its still $122. If the physician does medically necessary follow on care you can bill a separate 99292 for the physician.
 
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