ED Coding and Reimbursement Alert

Question: Our ED physician saw a patient in the morning for a critical care service. Later that same date, 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, and this second doctor provides services for  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 physicians from the same department can report critical care services if the cumulative time for each physician equals at least 30 minutes. You need to report all of these shared services together under one personal identification number (PIN), usually the one for the physician who provided the initial critical care service.
 
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 PIN. The total critical care time, as you stated, is 68 minutes. Suppose the first doctor performs 30 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 performs 38 minutes of critical care on the same patient. You can report 99291 if your physicians' shared services break down this way.
 
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. The CPT guidelines do not prevent multiple doctors from billing critical care, but many payers will consider two physicians using the same PIN as one provider and not pay separately. In this case, the dollar payment would be the same amount, only to one provider instead of two.