Wiki Need help w/ Critical Care

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ARCPC9491

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I am trying to create a half page sheet for only critical care, 99291 & 99292, with no diagnoses. The problem is I have a group of about 15 doctors that are trauma surgeons, as same specialty. There are some major issues.... for example, 5 doctors are seeing the patient on the same day at different times, all billing for critical care code 99291. They all send their billing to their billing folks at all different times - some same day, next week, next month. Bottomline is no one knows that anyone else billed for critical care, they mess up their billing and it's a huge mess since they can only be billed under one physician and get paid. Somehow (this is where you hopefully help!) I need to figure out how the physicians can communicate with each other about seeing the same patient on the same day for critical care, because they all have to state that in their notes so they aren't duplicative services and add up all their time for that day and bill appropriately 99291 AND 99292 and not just 99291 five times!!!!

So, I thought I would start with a superbill only for critical care, just 99291 and 99292 but how will I get these docs to come to this piece of paper so the coding/billing is all on the same page and in a timely fashion? And then plus if they do procedures on the same day I guess I'm going to have to incorporate this in there somehow too because the sheets can't be different because then things will get lost, modifiers omitted, etc, etc.... What a mess.

This has been difficult. :eek:
 
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I would not let them bill any critical care codes until the charts are complete. That way you can catch everything. It is better to submit claims a few days or even a week later and have them be correct than to send them out immediately and have to refund.

Being the same group/same specialty you have to add all the time together and only bill 99291x1 and 99292x?, so you could have situations were some providers only spend 25 minutes, normally billed as an E/M but when you add them together with the other providers you have enough to support the critical care codes.

If you could create a master check off sheet that stays in the patients chart stating who did critical care and when, assuming they fill it out, that would also help with billing. In a perfect world...sigh.

Just my thoughts, good luck

Laura, CPC
 
We don't do their billing I was asked to assist in this problem but that is a good idea to me atleast. Not sure if they will do that or not. Even though I insist they should. This is driving me crazy!
 
Maybe if they figure out that it impacts how they get paid, they'll listen...yah, right!! Anyway, we have a similar form that we attach to the top of the chart and it doesn't get billed out until it is complete. We have had some trouble in the past getting them to comply, but if you bring into play consequences of payment, fines or even ability to practice time (like we finally had to), you might get somewhere..as Laura stated..in a perfect world.
 
"The pink sheet"

Well ... one thing we do is to affix color-coded superbills to the front of patient charts. EVERY provider is to enter his/her charges on the appropriate superbill, and at discharge (or once a week if patient is inpatient longer than 7 days) our abstractor goes through, picks up the superbill(s), verifies documentation and sends through the charge(s). (Our cracker-jack abstractor actually goes through the entire chart page by page so even if the doc didn't make a mark on the superbill the charge will be captured. But if the doc DID mark the superbill and the abstractor doesn't find documentation the abstractor sends that doc a note saying documentaiton is missing and giving the doc 24 hours to provide the dictation or forego billing.)

The regular inpatient superbill is goldenrod. The observation superbill is lime green. Our regular "clinic" superbill is plain white. Maybe the critical care service superbill could be pink?

There are two key elements to this approach. One is to have one central "gatekeeper" (in our case the abstractor) who is basically looking at the chart in total to avoid duplicates and ensure everything is captured. The other is having a simple method for the providers to record what service they provided (or think they provided).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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