Critical Care

Question

A pulmonologist and cardiologist, from our group, were both called to see an inpatient. Both of the providers saw the patient and both performed critical care. Can they both bill for their services?

Answer

The answer depends if they saw the patient at the same time period or not. If they performed the visit together at the same time period the answer is no. They cannot bill for the same minutes as only one physician can bill for critical care at a time. However, if the visits occurred at different times, the physicians in the same group practice who have different medical specialties may bill and be paid without regard to their membership in the same group. As long as the services are not duplicative, the critical care services may be reported by each regardless of their group practice relationship as long as they are for different periods of time.

Question

What happens if the critical care services occur over the midnight hour?

Answer

The CPT guidelines state that when time-dependent services are performed continuously over midnight, time should be accrued for and reported as occurring on the pre-midnight date. However, once the service is discontinued or is noncontinuous, then the provider would begin a new time for the subsequent services on the post-midnight date.

Question

Does ATS recommend that we begin ordering the Lung Cancer Screening services for our patients?

Answer

At the time of the printing of this article, CMS has not yet posted billing instructions for Lung Cancer Screening to the contractors. The National Coverage Determination does have criteria available for providers to follow. We recommend that ATS members review the criteria carefully and if they believe a patient meets those criteria they may order the services. However, the patient should be notified in advance of the procedure that billing instructions and cost sharing has not yet been made available and providers can consider giving the patient an advance beneficiary notification informing the patient that without instructions there is a possibility of no payment by Medicare (education regarding ABNs see http://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/ abn_booklet_icn006266.pdf for details). We would also recommend you either hold claims until the instructions are published or contact your local Medicare contractor for advice in submitting claims.