Wiki Critical Care - I am billing for hospitalists

[Aly13]

Hi All-
I am billing for hospitalists who bill critical care. Medicare now says that 2 physicians in the same practice/speciality can bill critical care on the same day. 1st doc bills 99291 and the 2nd doc(who saw the patient at different time on the same day) can bill 99292 under his own NPI number despite the fact that 99292 is an add on code. Does anyone know how the time frames work with this. Example 1st doc bills critical care 99291 and documents 40 minutes. 2nd doc bills 99292 and documents 35 minutes. Does anyone have thoughts on if Medicare would deem this to be correct billing under the new rules. Appreciate any insight anyone has to offer.
Thanks
Aly

 

[RebeccaWoodward*]

Hi All-
I am billing for hospitalists who bill critical care. Medicare now says that 2 physicians in the same practice/speciality can bill critical care on the same day. 1st doc bills 99291 and the 2nd doc(who saw the patient at different time on the same day) can bill 99292 under his own NPI number despite the fact that 99292 is an add on code. Does anyone know how the time frames work with this. Example 1st doc bills critical care 99291 and documents 40 minutes. 2nd doc bills 99292 and documents 35 minutes. Does anyone have thoughts on if Medicare would deem this to be correct billing under the new rules. Appreciate any insight anyone has to offer.
Thanks
Aly

My MAC has guidance on this...

Jurisdiction 11 Part B

E/M Weekly Tip: Critical Care Billing Same Specialty/Group

If a provider in the same specialty/group provides 'staff coverage' or 'follow-up' for each other after the first hour of critical care services was provided (same calendar date), the subsequent visits by the 'covering' provider in the group must be billed using CPT critical care add-on code 99292. The appropriate individual NPI number must be reported on the claim.

For more information, please visit the Medicare Claims Processing Manual, 100-04, chapter 12, section 30.6.12 I at CMS website (PDF, 1 MB).


last updated on 09/05/2013


http://www.palmettogba.com/palmetto...ce=J11BL&utm_campaign=J11BLs&utm_medium=email

 

[Aly13]

Thanks Rebecca, so your take would be that I would add the times together. In this case I have 75 minutes, if I subtract 1 hour I am left with 15 minutes for my second physician. Since 99292 is used to report add'l blocks of time up to 30 minutes, I would still met the criteria to bill the 99292? If the scenario was that each doctor had 30 minutes of critical care time equaling an hour that in this case I would have no time left for the second physician to bill 99292. That is how I am reading it, any thoughts?