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99291 ed and admitting provider

Karen Posted Thu 13th of March, 2014 08:42:08 AM

Have a debate with a biller in regards to how we should bill Critical Care codes. We have providers at a hospital and there is the ED and the hospitalist and critical care unit. My quesiton is this... If the patient arrives to the ED department needing 30 minutes of Critical care services and then the care is transferred to a hospitalist that gives 40 minutes of Critical care services. How would each separate group code for those services. I say they both code 99291 because they are separate groups within the hospital. The biller showed me where Medicare approves 99292 to be alone but I have only found information in regards to if the providers were within the same group. Please help.

SuperCoder Answered Thu 13th of March, 2014 16:26:16 PM

Two providers of the same specialty, in the same group, providing the same E/M service on the same day, for the same patient are deemed to be the same provider so the first hour of critical care would be reported with 99291 and subsequent units of 99292 would be reported by the second provider as appropriate.

If two physicians of different specialties and different groups have the same scenario, both would report 99291 for the first hour of critical care they provide.

From the CMS Transmittal 1548:

The CPT code 99291 is used to report the first 30 - 74 minutes of critical care on a given calendar date of service. It should only be used once per calendar date per patient by the same physician or physician group of the same specialty. CPT code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care

Clinical Example of Correct Billing of Time:
A patient arrives in the emergency department in cardiac arrest. The emergency department physician provides 40 minutes of critical care services. A cardiologist is called to the ED and assumes responsibility for the patient, providing 35 minutes of critical care services. The patient stabilizes and is transferred to the CCU. In this instance, the ED physician provided 40 minutes of critical care services and reports only the critical care code (CPT code 99291) and not also emergency department services. The cardiologist may report the 35 minutes of critical care services (also CPT code 99291) provided in the ED. Additional critical care services by the cardiologist in the CCU may be reported on the same calendar date using 99292 or another appropriate E/M code depending on the clock time involved.

Karen Posted Tue 18th of March, 2014 10:09:21 AM

So if they were part of separate groups and Critical care was provided on the same date how would that apply? For example Patient in Critical at one hospital and has to be transferred to another and has to have critical care services provided on the same date. How would that be coded?

SuperCoder Answered Wed 19th of March, 2014 02:20:33 AM

In the scenario below, different groups and different hospitals, both providers would use 99291 to report the first hour of critical care.

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