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Pulmonology Coding Alert

Reader Questions:

Avoid 2 Pulmonologist Reporting Same-Day Critical Care

Published on Fri Jul 23, 2010

Question:

A pulmonologist in our practice saw a patient in the morning for critical care. In the evening, a second pulmonologist saw the same patient. I heard the correct way to code this scenario would be to add the minutes together and use only one physician. Is it so, or do I bill critical care for both doctors separately?

Rhode Island Subscriber

Answer:

According to Section 30.6.12E of the Medicare Claims Processing Manual, physicians in the same group practice who have the same specialty may not each report CPT initial critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) for critical care services to the same patient on the same calendar date. Medicare payment policy states that physicians in the same group practice who are in the same specialty must bill and be paid as though each were the single physician.

Option: Medicare Claims Processing Manual, Pub. 100-04, Chapter 12, Section 30.6.5 states that instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

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