ED Coding and Reimbursement Alert

Question: Our ED physician saw a patient in the morning for a critical care service. Later the same day, a different physician, who was on-call, saw the same patient for critical care services. I know that I should add up the interspersed critical care time blocks if the same physician provided the services for each episode. But how should I bill when one doctor signs off to another physician from the same ED groupand this second doctor tends to the patient for subsequent episodes of critical care on the same date of service? The total time between the two physicians was 68 minutes.

North Carolina Subscriber

Answer: Multiple emergency physicians from the same emergency department can report critical care services if the initial critical care time billed as 99291 is met by a single physician.

In your case, you should bill 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) under the first doctor’s personal identification number. The total critical care time was 68 minutes.

Suppose the first doctor performed 38 minutes of critical care services on a patient with respiratory failure at 9 a.m. Later that day, the other doctor in the same practice performed 30 minutes of critical care on the same patient. You can report 99291 if your physicians’ shared services breakdown this way.

Be aware: Medicare will not allow two physicians to bill for the same minute of critical care time, but both could conceivably bill for critical care minutes in the same hour of the day. CPT does not prevent multiple doctors from billing critical care, but many payors will consider two physicians using the same tax ID number (TIN) as one provider and not pay separately.