Medical Billing Critical Care Myths Take II

Medical Billing Critical Care Myths Take II

There are several layers of critical care medical billing myths. Previously discussed were two myths . Now an additional three misconceptions will be brought to the forefront. Maximizing your revenue means to fully understand critical care medical billing.

One common myth for critical care medical billing is that the time spent with the patient must be continuous. In reality, the physician’s time can be split up in several different chunks. For example, the doctor can visit a patient at his/her bedside for 25 minutes and later view in x-ray of that patient for ten minutes. This would count as 35 minutes for that patient. As long as the care was critical in nature you could use the critical care medical billing codes.

Although the current procedural terminology code 99291 allows medical billing for an evaluation and management code on the same day, most payers will not allow it. Medicare is a little different. In some instances you can bill for an evaluation and management code plus a critical care code. However, if the evaluation and management medical billing comes second with the critical care code first, Medicare will not pay. However, if the evaluation and management exam comes first you have a chance for medical billing reimbursement from Medicare.

Unfortunately, the next myth is very common. Many people believe that two physicians can bill for critical care for the same patient on the same day. Even if two physicians treat a critically injured patient, only one can bill for critical care services. For example , if the trauma doctor and the emergency department doctor treat a patient after car crash, only one can do medical billing for critical care. The other physician can bill four a consultation or an evaluation and management.

Most physicians aren’t thinking about medical billing when performing critical care services. It is the medical billing staff’s job to correctly analyze and code critical care.

View all Articles by: Melissa Clark, CCS-P