Ob-Gyn Coding Alert

When a patient is in the intensive care unit (ICU), the ob/gyn can still report concurrent care as long as you follow documentation rules.

When two physicians see a patient in the ICU, some coders may question whether they can report concurrent care services because they believe that if a patient is in the ICU, she must be receiving critical care. "Only one physician can bill critical care at a specific time," says Jean Ryan-Niemackl, LPN, CPC, compliance analyst for QuadraMed in Fargo, N.D.

Although Medicare allows only one physician to report for a given hour of critical care, a second physician can report a subsequent hospital care code if he also provides care to the critically ill or injured patient. More than one physician can provide critical care services to the same patient on the same day if the physicians meet the requirement for critical care services. They just cannot provide critical care during the same one hour.

"This is where it is important for the doctors to document the time of the visits because only one physician can provide critical care at a time," Revel says. If the physician seems to be performing a regular hospital visit while another is providing critical care because the documentation lacks time notations, insurance carriers will likely see the care as redundant and refuse to pay, she adds.

Remember that being in the ICU does not necessarily mean the patient is receiving critical care. If the patient is not undergoing critical care, there are no restrictions on reporting concurrent care in the ICU, and you should use regular subsequent hospital care codes (99231-99233).