Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Critical care involving two physicians from the same specialty

SuperCoder Posted Wed 26th of January, 2011 19:30:49 PM

When two physicians of the same specialty see the same patient on the same day at different times, I add the times for each physician together (as long as one meets the minimum of 30 min)in order to determine what code(s) to bill.

I am being told by another coder that you cannot add the two times together unless one of the physicians has spent a minimum of 60 minutes with the pt, and furthermore, that, if the first physician does NOT see the pt for 60 min, a 99291 would be billed for him and a 99292 would be billed for the second physician even if the two times added together do not equal more than 74 minutes.

Here is a scenario we both coded:

Dr. A 30 min cc
Dr. B 20 min cc
Dr. C 25 min cc

I coded: 99291 and 99292 (total time = 75).
She coded 99291 and 99292 x 2 (one code for each person.

What is the right way to code cc when two physicians are involved?

Thanks!

Nikhil Answered Thu 27th of January, 2011 20:19:14 PM

Rule:
Code 99291 is always the primary code (reported once per physician/group per day) for critical-care services. Code 99292 can be reported in multiple units per physician/group per day according to the number of minutes spent after the initial hour .
Analysis:-
In order to code either of these you must meet the defined time by 1/2 way. So in order to code 99291, you must have at least 30 minutes. In order to code the 99292 for each additional 30 minutes, you again must meet this code 1/2 way at 15 minutes.

The reason 99291 is stated as 30-74 minutes is because that is 1 minute short of meeting the 1/2 mark to code 99292. At 74 minutes you have 60 minutes for 99291 with only 14 minutes left over. That 14 minutes does not meet the 1/2 way mark in order to code 99292. You are one minute short.

But, if you have 75 minutes:Code 99291 and 99292. Thats 60 minutes for the 99291. The left over 15 minutes meets the 1/2 way mark required for 99292

Based on the above premise, if you analyze, you will come to a conclusion of: 99291 x 1 and 99292 x 1

Related Topics