Other Coding Requirements fro Critical Care
- Only one physician may bill for critical care services during any one single period of time even if more than one physician is providing care to a critically ill/injured patient.
- Physicians assigned to a critical care unit (hospitalist/intensivist) may not report critical care based on a “ per shift ” basis.
- Services cannot be reported as a split/shared service when performed by a physician and a qualified NPP of the same group practice.
- Physicians in the same group practice, with the same specialty, may not report 99291 for the same patient on the same calendar date.
- Concurrent care by more than one physician representative by different specialties is payable if the services meet critical care requirements, (i.e., must be medically necessary and non-duplicative.)
- Hospital emergency department services are not payable for the same date as critical care services when provided by the same physician or physicians of the same specialty.
- Critical care services will not be paid on the same calendar date that a physician reports an unbundled procedure with a global surgical period, unless the critical care is billed with modifier -25 to indicate a significant, separately identifiable E/M service was performed.