SCCM Resource Library-Advanced Practitioners and Critical Care for Medicare Patients

Pdf Summary

The document discusses billing and coding guidelines for Advanced Practitioners (APPs) and physicians providing critical care services, particularly in the context of Medicare. According to the Centers for Medicare and Medicaid Services (CMS), APPs include Nurse Practitioners (NPs), Physician Assistants (PAs), and Clinical Nurse Specialists (CNSs), who can perform critical care, assist in surgery, and conduct procedures within their scope of practice as defined by state laws.<br /><br />Critical care billing for APPs and physicians involves specific rules. For instance, critical care cannot be split/shared between a physician and an APP in the inpatient hospital setting. Each professional bills separately: the first 74 minutes of care must be billed by a single practitioner under CPT code 99291, and additional time is billed under code 99292. APPs must use their National Provider Identification (NPI) number unless they are part of the hospital's Medicare cost report, in which case, the billing is reassigned to the hospital.<br /><br />Examples illustrate these guidelines: In one, an NP provides initial critical care, and the physician arrives later, leading to separate billing for each. Another example involves a cardiologist and an APP providing critical care at different times, each billed separately.<br /><br />CMS also states that only one practitioner from the same specialty within a group practice can bill the initial critical care code on the same day for the same patient. The guideline suggests checking with Medicare contractors and commercial payors, as specific billing rules can vary.<br /><br />The document also promotes the Society of Critical Care Medicine’s courses for healthcare professionals to improve patient outcomes and reduce healthcare costs. These courses cover a variety of essential and advanced critical care topics.

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Administration, 2020, 00:03:57

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This article was originally published in the Spring 2020 Issue of Critical Connections.

If the APP is a hospital-employed practitioner and is included on the Medicare cost report, the APP cannot bill for critical care services because those services are included in the hospital billing. If the APP is excluded from the hospital Medicare cost report, he/she can bill professional services, including critical care, using the individual’s National Provider Identification (NPI) number. If the APP is employed by the hospital, payment should be reassigned to the hospital. In this instance, the employer (hospital) bills the APP’s professional services under Medicare Part B using the APP’s NPI number.

Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.Deborah Grider

Meta Tag

Content Type Article

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Economics

Tag APP Administration

Year 2020

Keywords

billing guidelines

coding guidelines

Advanced Practitioners

critical care services

Medicare

Centers for Medicare and Medicaid Services

CPT code 99291

CPT code 99292

National Provider Identification

Society of Critical Care Medicine

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