Outpatient Facility Coding Alert - 2007 Issue 14
MYTHBUSTER UPDATE: 2 Doctors, Simultaneous Critical Care Could Lead To Denials
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Article Overview
This article reviews a Medicare coding and billing issue involving concurrent critical care services and the need to verify local carrier guidance, FAQs, and claim handling practices. It is aimed at coders, billers, and physician practices that submit critical care claims and want to understand how carrier-level policies may affect payment and denials. The discussion also covers documentation and timing considerations at a general level, along with when appeals may be relevant.
Why This Topic Matters
Concurrent critical care billing can be denied depending on local policy, so practices need to know that national guidance may not be the only standard that applies. Understanding the topic helps reduce avoidable denials and supports better claim review and documentation workflows.
Article Sections
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Check your local carrier's policies
Introduces the issue of concurrent critical care billing and explains why local payer guidance may be important. The section frames the topic around Medicare Part B carrier policies and related FAQs.
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Example and carrier policy variation
Summarizes how different carriers may address the same critical care situation and why claims may be treated differently across payers. It highlights the need to review carrier-specific policy language before billing.
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Questions to resolve before billing
Discusses general steps practices may take when more than one physician could have been involved with the patient at the same time. It addresses coordination with other providers and access to records as part of claim review.
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Claim submission, denials, and appeals
Explains that overlapping claims may not be identified until submission and that denials can occur as a result. The section also notes that appeals may be considered when the billed services can be distinguished.
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Documentation and time considerations
Covers general expectations about physician availability during billed critical care time and the role of documentation. It also notes that not every supportive activity necessarily counts toward billable critical care time.
What You Will Learn
- How local carrier policies can affect concurrent critical care billing
- Why practices should check FAQs and payer guidance before submitting claims
- What general issues may arise when multiple physicians are involved with a critically ill patient
- How claim denials and appeals may occur in overlapping-service situations
- What broad documentation and timing concerns are discussed for critical care services
Who Should Read This
- Physician coders
- Medical billers
- Revenue cycle staff
- Physician practices
- Hospital coding teams
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