Q&A: Billing for critical care

August 15, 2008

Two physicians' time may not be combined to make up the 30-74 minutes of critical care required to bill a 99291.

Q: Our pulmonology practice routinely provides inpatient critical care to our patients and also to our on-call patients. Many times, I will see a patient in the ICU in the morning, only to have one of my partners called back to see the patient in the evening. My partner also provides critical care, but when we bill the service, one of the claims is denied. I understand the rules were changed allowing physicians to bill separately. What do we need to do?

A: Medicare has clarified critical care codes with its transmittal 1530. If physicians in the same group are of different specialties, each may charge a critical care visit (dependent upon the time spent and the medical necessity of the service) if each saw the patient as you describe. If, however, the physicians are of the same specialty, the services within the same date must be combined and billed with one provider number. Two physicians' time may not be combined to make up the 30-74 minutes of critical care required to bill a 99291, nor may an NPP provide any service used to calculate the critical care time. If the time is less than 30 minutes, a level of subsequent inpatient care should be used.