TTcpc
Guru
Hello,
I am trying to clarify something for the group that I work with regarding physicians and NPs providing critical care services. I know that critical care is not a split/shared service and that their time cannot be combined to meet the inital 99291. My question is, if I have an NP who does 60 minutes of critical care time and then an MD in the same group comes in and provides an additional 25 minutes of time, then can we bill 99291 and 99292? I am aware that the timeframe for 99291 is 30-74 minutes; however CMS states in the claims manual 30.6.13 Section H : "However, if a physician or qualified NPP within a group provides ?staff coverage? or ?follow-up? for each other after the first hour of critical care services was provided on the same calendar date by the previous group clinician (physician or qualified NPP), the subsequent visits by the ?covering? physician or qualified NPP in the group shall be billed using CPT critical care add-on code 99292.
So my question is: is the first provider only responsible for the first 60 minutes and at 61 minutes the second provider can bill for 99292 as long as they exceed the 15 minute threshold????
This is a very heated topic that I have walked into with this job and I want to make sure that we get it cleared up. The medical director has an article that he interpretes as requiring only reaching the 31 minute by the first one and past that the second can start their time. I am trying to set up our policies according to CMS and our local carrier/Novitas, but as we all know sometimes they are as clear as mud then they want to punish you if you don't follow them the way that they do.
Thank you!!
I am trying to clarify something for the group that I work with regarding physicians and NPs providing critical care services. I know that critical care is not a split/shared service and that their time cannot be combined to meet the inital 99291. My question is, if I have an NP who does 60 minutes of critical care time and then an MD in the same group comes in and provides an additional 25 minutes of time, then can we bill 99291 and 99292? I am aware that the timeframe for 99291 is 30-74 minutes; however CMS states in the claims manual 30.6.13 Section H : "However, if a physician or qualified NPP within a group provides ?staff coverage? or ?follow-up? for each other after the first hour of critical care services was provided on the same calendar date by the previous group clinician (physician or qualified NPP), the subsequent visits by the ?covering? physician or qualified NPP in the group shall be billed using CPT critical care add-on code 99292.
So my question is: is the first provider only responsible for the first 60 minutes and at 61 minutes the second provider can bill for 99292 as long as they exceed the 15 minute threshold????
This is a very heated topic that I have walked into with this job and I want to make sure that we get it cleared up. The medical director has an article that he interpretes as requiring only reaching the 31 minute by the first one and past that the second can start their time. I am trying to set up our policies according to CMS and our local carrier/Novitas, but as we all know sometimes they are as clear as mud then they want to punish you if you don't follow them the way that they do.
Thank you!!