# Critical Care Time w/NP & PA



## Mindy Davis (Jan 16, 2010)

Sometimes with have NP's or PA's that see a pt and have to turn the patient's care over to one of our ER Physicians. My question is that if the patient meets critical care status how do I calculate the time? Do I add the time the NP/PA and Physician time together to get my critical care time or do I just add the phyisicans?

Thanks 
Mindy


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## cathyflower (Jan 16, 2010)

I believe critical care time cannot be shared. It can be split between two doctors depending on how much time they say is spent. 99291, 99292 . I am not sure of the answer. Would it depend on the insurance carrier ?


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## j.berkshire (Jan 18, 2010)

The Medicare Carrier's Manual addresses this by saying:  "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."

So, in summary, you bill the NPP's time or the physician's time, but you cannot combine the times. (http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf, page 58)


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