Wiki Critical Care Billing 99291

[Salemcoder]

We have received denials from one insurance company when billing the critical care code because another doctor (from another clinic, and another specialty) had already billed it for the same day.

The guidelines specify "99291 should be used only once per date even if the time spent by the physician is not continuous on that date." We have interpreted that to mean that once per clinic. Has anyone else run into this, and have any suggestions?

 

[abishard]

More than one physician cannot be providing critical care at the same time per Medicare guidelines.

 

[FTessaBartels]

At the same time

You are right about "at the same time" but that means literally. So if Dr Cardiac saw the patient at 8:00a.m. and was providing one hour of critical care time, and Dr Renal saw the patient at 1:00pm and also provided one hour of critical care, they should both be able to use the 99291 code.

NOTE: just because the patient is in the ICU does not mean that the physician is actually providing critical care.

But if you have met the standard for 99291, I'd appeal with copies of both notes.

F Tessa Bartels, CPC, CEMC