ED Coding and Reimbursement Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: An ED physician and an admitting physician both spend enough time with a critically ill patient to bill for critical-care services, but the ED bill is rejected because the carrier already paid a critical-care charge to the admitting physician for that visit. How should I code this?

Illinois Subscriber

Answer: The crux of the question is whether 99291 (the first hour of critical care) can be billed under two different tax ID numbers on the same day. This seems to be a rare problem. The common scenario is a critically ill patient presents to the ED, receives 30 minutes of care by the ED physician and upon initial stabilization and at least initial review of labs, x-rays, ABGs, etc., is admitted to the hospital.
 
At this point the ED calls the intensivist or admitting physician, who may be already frequently checking in with the ED, to assume control of the patient. Once the admitting physician assumes control of the patient, the clock stops for the ED physician and starts for the admitting physician. It is true that two different doctors may not claim the same "minutes" toward exclusive care of the patient. This basically imposes an artificial "line in the sand" because the ED physician may still remain peripherally involved in the care, such as reviewing additional labs, making consults, etc.
 
However, in fairness to the admitting physician, once he or she takes clinical control of the major direction and decisions of the patient's care, his meter is running and the ED physician's is not.