A: The codes can differ, and it can get confusing. Today’s webinar discusses codes for professional charges.
Q: If two providers in the same group see the patient on the same date of service (day shift and night shift for example) and document critical care time how will we code the visit for both providers’ services?
A: Yes, hopefully this was answered in the example in the presentation. To clarify again, as long as the service of both providers doesn’t overlap, and at least one provider documents enough time to meet the minimum required for the first initial code, 99291, the time of both providers can be combined. If the time is only to bill one unit of 99291, then best practice is to have written policy, agreed upon by everyone, on who gets to bill the critical care. If the combined time is enough to report the 99291 and the add-on code +99292, CMS guidance states to bill the 99291 under one provider and the add-on code under the second provider.
Q: If provider documented pt went into cardiac arrest and died in the ED, however never documented as critical care, do guidelines support reporting 99291. Would you query MD to amend note to indicate time instead.
A: I would not code critical without the provider documenting he/she performed critical care. This could be a case where the patient demise happened before the provider had a chance to provide critical care and it would not appropriate to bill it as such. However, if there is conflicting documentation and you do think the provider provided critical care is it fine to send a query. The query would need to be worded carefully, so that the question asked is if the provider provided critical care, rather than instructing him to add the time and statement of critical care.
Deanna Upston, CPMA, CPC, COSC
Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience. Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians. She has put together multiple education sessions for both provider and coder. She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software.