2022 Critical Care Split/Shared

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Joined: Mon Apr 02, 2018 5:20 pm

Mon Feb 14, 2022 5:32 pm

I'm trying to confirm who bills for the third visit in the scenario below.

Patient is critically ill: NP documents 30 minutes of time. Dr. A document 55 minutes. So the total is 85 minutes.

So Dr. A submits a bill for first hour CC and the second 30 minutes.

Then at night patient require further management at 9 pm by Dr. B who was on call at night. He documents 25 minute. That brings the total to 110 minutes which will qualify for a second 30 minutes code.

The question is who bills for this third code?

What I'm gathering from research is that if split/shared is used at all, then the whole day is counted as split/shared, and only Dr. A would bill for all of the critical care time on that date because the critical care split/shared billing is following the same guidance as the prolonged services, even though prolonged services don't apply to critical care.

If the first two providers didn't bill as split/shared and billed concurrently, we would only count Dr. A's time, 55 min. he would bill 99291, then the provider on call at night with 25 minutes could have billed for 1x 99292, because total aggregated time would be 80 minutes, correct?
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