E/M Weekly Tip: Critical Care Billing Same Specialty/Group

If a provider in the same specialty/group provides staff coverage or follow-up for each other after the first hour of critical care services was provided (same calendar date), the subsequent visits by the "covering" provider in the group must be billed using CPT critical care add-on code 99292. The appropriate individual NPI number must be reported on the claim.

Drs. Smith and Jones, pulmonary specialists, share a group practice. On Tuesday Dr. Smith provides critical care services to Mrs. Benson who is comatose and has been in the intensive care unit for four days following a motor vehicle accident. She has multiple organ dysfunction including cerebral hematoma, flail chest and pulmonary contusion. Later on the same calendar date, Dr. Jones covers for Dr. Smith and provides critical care services. Medically necessary critical care services provided at the different time periods may be reported by both Drs. Smith and Jones. Dr. Smith would report CPT code 99291 for the initial visit and Dr. Jones, as part of the same group practice would report CPT code 99292 on the same calendar date if the appropriate time requirements are met.

For more information, please visit the Medicare Claims Processing Manual, 100-04, Chapter 12, Section 30.6.12 I at CMS website (PDF, 1.3 MB).