jbonjour
New
I have a physician asking if the NP does the H&P for an inpatient admit, can he bill for the critical care if they don't mix their time, exam or treatment.
This is what I have told him:
CPT Code 99291
The initial critical care time, billed as CPT code 99291, must be met by a single physician or qualified NPP. This may be performed in a single period of time or be cumulative by the same physician on the same calendar date. A history or physical exam performed by one group partner for another group partner in order for the second group partner to make a medical decision would not represent critical care services
As well as:
Split/Shared Service
A split/shared E/M service performed by a physician and a qualified NPP of the same group practice (or employed by the same employer) cannot be reported as a critical care service. Critical care services are reflective of the care and management of a critically ill or critically injured patient by an individual physician or qualified non-physician practitioner for the specified reportable period of time.
When CPT code time requirements for both 99291 and 99292 and critical care criteria are met for a medically necessary visit by a qualified NPP the service shall be billed using the appropriate individual NPI number. Medically necessary visit(s) that do not meet these requirements shall be reported as subsequent hospital care services.
Am I missing something here? When my NP see the patient and perform the H&P, the physician comes by after, and performs the critical care services. The NP knows when she is seeing that patient if it is a critical situation or not. So the physician is seeing that patient sooner since the NP informed them.
Can we bill the H&P under the NP then critical care under the physician? (Assuming it meets guidelines for critical care)
This is what I have told him:
CPT Code 99291
The initial critical care time, billed as CPT code 99291, must be met by a single physician or qualified NPP. This may be performed in a single period of time or be cumulative by the same physician on the same calendar date. A history or physical exam performed by one group partner for another group partner in order for the second group partner to make a medical decision would not represent critical care services
As well as:
Split/Shared Service
A split/shared E/M service performed by a physician and a qualified NPP of the same group practice (or employed by the same employer) cannot be reported as a critical care service. Critical care services are reflective of the care and management of a critically ill or critically injured patient by an individual physician or qualified non-physician practitioner for the specified reportable period of time.
When CPT code time requirements for both 99291 and 99292 and critical care criteria are met for a medically necessary visit by a qualified NPP the service shall be billed using the appropriate individual NPI number. Medically necessary visit(s) that do not meet these requirements shall be reported as subsequent hospital care services.
Am I missing something here? When my NP see the patient and perform the H&P, the physician comes by after, and performs the critical care services. The NP knows when she is seeing that patient if it is a critical situation or not. So the physician is seeing that patient sooner since the NP informed them.
Can we bill the H&P under the NP then critical care under the physician? (Assuming it meets guidelines for critical care)