• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Q&A: Coding when two physicians bill for critical care


Critical care is the total of care rendered by a physician within a calendar day and may be rendered by more than one physician.

A: Critical care is defined as the direct delivery of medical care by a physician for a critically ill or critically injured patient, with high probability of imminent or life-threatening deterioration of the patient's condition. Critical care is the total of care rendered by a physician within a calendar day and may be rendered by more than one physician.

However, if both physicians are within the same tax ID group and are the same specialty or subspecialty, the care the two physicians render to the patient within the calendar day is normally combined and billed under one physician's National Provider Identifier. There are few exceptions to this scenario, but if the patient received critical care early in the day, improved, and then later in the day deteriorated, some insurers have allowed a second critical care visit performed by another physician within the same group later in the day (because of a new diagnosis, for example).

Critical care is a type of service; it is not a place of service. Simply because the patient is in the intensive care unit, neonatal intensive care unit, or pediatric intensive care unit does not mean critical care codes can be used-they should be used only if the criteria are met.

The author, vice president of operations for Reed Medical Systems in Monroe, Michigan, has more than 30 years of experience as a practice management consultant, and is also a certified coding specialist, certified compliance officer, and a certified medical assistant.

Related Videos
Peter H. Reilly, HUB International
Peter H. Reilly, HUB International: ©HUB International
Peter H. Reilly, HUB International
Robert E. Oshel, PhD
Gary Price, MD, MBA
Victor J. Dzau, MD, gives expert advice
Ron Holder, MHA, gives expert advice
remote patient monitoring
© 2023 MJH Life Sciences

All rights reserved.