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Question from mt Dr re: Critical Care billing

  1. Default Question from mt Dr re: Critical Care billing
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    I have a billing question for you in a new area of medicine, and I don't believe you have any current experience with it. It involves charging for a critical care consult. Currently, I frequently obtain these consults from physicians to help care for patients who have a complicated post-op course. I will give you a scenario and I would like you to investigate and get back to me.

    The scenario is: I operate on a patient and he has some complications. The patient needs to be in the intensive care unit for longer than usual; this is "critical care". I need help caring for the patient who is critically ill and consult another physician who is specialty trained in critical care. This new physician will bill the patient separately for his care. To date you are never aware of this, and don't get involved.

    My question is: If I were to hire a physician with specialty training in critical care and asked him to consult on a complicated patient; could we bill for his services?
    To be clear; this new physician would be my employee and work for CTS Lico. He would not be the one who performed the surgery on the patient; I would do the surgery. However, he may have been an assistant on the surgery. He would also have the necessary specialty board certification in critical care. Can I bill for his services to manage a critically ill post-op open heart patient?

    I am under impression that anyone working under our tax id (surgeon who performed surgery) cannot bill within post op period regardless if its related to surgery. Does anyone have different ideas/answers?

  2. #2
    Milwaukee WI
    Default Different specialty?
    If your practice hires an intensivist or cardiologist to manage the critically ill patients postoperatively, AND that physician has a different specialty than the operating surgeon, then, YES, you can bill separately for the services provided by that physician. BECAUSE .. that physician was not involved in the surgery and is of a different specialty than the operating surgeon. This is the same principle as a very large multi-specialty practice where you have CV surgeons and Cardiologists and Pulmonologists who may all have cared for a critically ill patient during one hospital stay and can all bill for their services; only the operating surgeon (and his/her colleagues in the same specialty, same practice) are covered by the global period.

    HOWEVER ....
    If you hire another surgeon who is also certified as an intensivitis (for example), and that new physician is also assisting with surgery (and billed out as an assist), then NO postoperative care can be coded for either surgeon.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 09-12-2011 at 03:36 PM.

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