The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
Critical Care Coding
Critical care codes 99291 and 99292 are time-based. The question has arisen, “Can both the physician and nurse practitioner bill for combined time with a critical care code?” Essentially, the answer is no. The Society for Critical Care Medicine indicates that critical care is a physician-only service. The Medicare carriers can be very strict. Nurse practitioner time, staff time, and even the time of other physicians in the group are not necessarily counted toward critical care timing by some carriers. Other carriers will allow two physicians in a group to combine their time to get to a critical care code.
In order to ensure correct coding and documentation for a critical care code you must document total time involved in providing critical care services. If you plan to code both an E/M code and critical care on the same day, two distinct face-to-face service notes must be written. If a resident is involved, good documentation of the attending physician’s involvement in that critical care encounter must be present.
You must establish medical necessity. Please remember that just because the patient is in the intensive care unit, does not mean that special critical care services were needed on that day. Documentation of the need for those services must be readily apparent. An example is a patient who is septic, hypotensive and is also seen by a dermatologist to treat a rash. The intensivist-internist may file a critical care code; the dermatologist may not.