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Pulmonology Coding Alert

Reader Question:

Critical Care by Two Physicians

Published on Thu Nov 01, 2001

Question: A nephrologist admits a patient with acute renal failure to the intensive care unit (ICU). The patient develops pulmonary edema and severe hypoxemia. He is intubated, and mechanical ventilation is started. A pulmonologist is called in to manage the respiratory failure. The nephrologist informs the pulmonologist that he will bill for critical care. Can the pulmonologist also bill for it?

Pennsylvania Subscriber
 
Answer: Yes, the pulmonologist can bill for critical care as well. There are three rules for two physicians to bill critical care on the same day for the same patient:
 
1. The physicians must be of different specialties or subspecialties.
 
2. They have to use two different primary ICD-9 codes.
 
3. They must bill for critical care during different time periods.
 
The two physicians must coordinate this together.

The pulmonologist should bill the appropriate critical care code (99291-99292) depending on the time spent with the patient. He or she may also code 514 (pulmonary congestion and hypostasis) for the pulmonary edema, and 799.0 (asphyxia) for the hypoxemia, making sure the nephrologist bills a different ICD-9 code, e.g., 580.4 for the renal failure.
 
In this case, try to bill the actual clock time. For example, if the pulmonologist sees the patient from 10 a.m. to 11 a.m., document "10 a.m. to 11 a.m.," instead of "one hour." There are no published guidelines requiring the documentation of clock time, but it can help the payer verify that the two physicians saw the patient at different times. The cumulative amount of time will also satisfy documentation guidelines.
 
Note: When billing critical care time, make sure the patient's condition meets the definition for critical care according to the CPT guidelines.
 
Answers to Reader Questions and You Be the Coder provided by Walter O'Donohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP; and Carol Pohlig, RN, CPC, reimbursement analyst for the office of clinical documentation at the University of Pennsylvania in Philadelphia.

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