Primary Care Coding Alert

Question: Our FP was paged to the emergency room (ER) at 1 a.m. to treat one of his patients with significant heart disease. The patient was arresting when he arrived, and the doctor performed chest compressions and talked with the patients family. The ER doctors want to bill critical care, and our doctor wants to bill critical care. Can we both report it?

Florida Subscriber

 
Answer: Both doctors can bill the appropriate critical care codes (99291-+99292). The FP should bill the critical care code depending on the time spent with the patient. He or she may also use 416.x (Chronic pulmonary heart disease). Use 99291 for 30-74 minutes spent with the patient and +99292 for each additional 30 minutes. The physician must remain on the same floor as the patient for the duration of time critical care is billed.
  
Two physicians billing for critical care for the same episode of care may raise questions of concurrent care on the part of some payers. If so, be prepared to show either that the FP and ER physicians provided critical care at different times or that the patients condition warranted two physicians providing critical care simultaneously.