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Thread: MLP shared Critical Care

  1. #1
    Join Date
    Apr 2007

    Default MLP shared Critical Care

    AAPC: Back to School
    I've been told that I can code Critical Care as a shared MLP visit.

    My understanding is that only physicians can claim critical care.

    In the CPT book it does describe physicians but I don't find a specific reference that only physicians can provide critical care.

    Can anyone help me with a reference I can pass on to my co-workers?

    Thank you for your help!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default NP or PA scope of practice

    It depends on the NPs or PAs scope of practice.

    If you NP or PA is credentialed and critical care is in their scope of practice, you should be able to use those codes when billing under the NP/PAs name and number.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007


    I did find this information but not in the CPT book but on website http://www.aapa.org/gandp/3rdparty.html#billing

    Do you think this still applys to the scope of practice or state they are providing service?

    Shared Visit Billing in a Hospital Setting

    On October 25, 2002, CMS issued new rules giving PAs and their supervising physicians increased latitude in hospital and office billing for E/M services. The new requirement (Medicare Transmittal 1776) allows PAs and physicians who work for the same employer/entity to share visits made to patients the same day by billing the combined work under the physician's NPI number for reimbursement at 100 percent of the fee schedule even if the PA did the majority of the work.

    This billing option does not apply to consults (per Medicare Transmittal 788) or extend to procedures, or critical care services. The criteria for shared visit billing are s follows:

    • Both the PA and the physician must work for the same employer (e.g., same group practice, same hospital, or PA is employed by a solo physician).

    • The service provided is a non-consultation E/M service, not a procedure and not a critical care service.
    • The physician must provided some face-to-face portion of the E/M visit; simply reviewing or signing the patient's chart is not sufficient.
    • Both the PA and the physician must see the patient on the same calendar day.

    If the physician does not provide some face-to-face portion of the E/M encounter, then the service is appropriately billed at the full fee schedule amount under the PA's NPI number (or PIN) with reimbursement paid at the 85 percent rate.
    Last edited by lgrennan; 04-16-2009 at 03:15 PM.

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