Can an Intensive Care Unit (ICU) physician with nephrology training bill for critical care services and Continuous Renal Replacement Therapy (CRRT) procedures?

From the Guidelines

An ICU physician with nephrology training can bill for critical care services and Continuous Renal Replacement Therapy (CRRT) procedures, provided they follow specific billing requirements and document the services accurately. When billing for both critical care services and CRRT procedures, it is essential to document the critical care services separately from the CRRT procedure, ensuring that the time spent managing the CRRT is not counted toward the critical care time 1. Critical care billing typically requires at least 30 minutes of direct patient care, with specific CPT codes used for billing (e.g., 99291 for the first 30-74 minutes, 99292 for each additional 30 minutes). In contrast, CRRT procedures are billed using specific procedure codes (e.g., 90945 or 90947 for dialysis procedures). The physician must have the appropriate credentials and privileges to perform both services, and the medical necessity for both must be clearly documented, detailing the patient's critical condition and the specific indication for CRRT, such as acute kidney injury, fluid overload, or electrolyte imbalances. Key considerations for billing include:

• Accurate documentation of critical care services and CRRT procedures
• Use of appropriate CPT codes for billing
• Medical necessity for both critical care services and CRRT procedures
• Physician credentials and privileges for performing both services. It is also worth noting that clinicians can bill for shared decision-making services using Medicare-reimbursable Current Procedural Terminology codes 99497 and 99498, as emphasized in the context of patient-centered care for seriously ill patients with kidney disease 1.

From the Research

Billing for Critical Care Services and CRRT Procedures

• An Intensive Care Unit (ICU) physician with nephrology training can provide critical care services and Continuous Renal Replacement Therapy (CRRT) procedures, as nephrologists play a crucial role in the care of critically ill patients with acute kidney injury (AKI) 2, 3.
• The role of the nephrologist in the ICU has evolved, and they are often involved in the management of patients requiring CRRT 2.
• CRRT is a common treatment for AKI in the ICU setting, and nephrologists are responsible for prescribing and monitoring this therapy 4, 5, 6.
• While there is no direct evidence on billing practices, it can be inferred that an ICU physician with nephrology training can bill for critical care services and CRRT procedures, as they are qualified to provide these services 2, 3.

Qualifications and Expertise

• Nephrologists are qualified to provide critical care services, including CRRT, as part of their training and expertise 2, 3.
• Critical care nephrology has become an established specialty, and nephrologists are recognized as leaders in the care of critically ill patients with AKI 2, 3.
• The American journal of kidney diseases emphasizes the importance of nephrologists being comfortable caring for critically ill patients, including those requiring CRRT 3.

Clinical Practice and Guidelines

• The use of CRRT in the ICU setting is guided by clinical practice guidelines and recommendations, which emphasize the importance of monitoring and adjusting therapy to optimize patient outcomes 4, 5.
• Nephrologists are responsible for developing and implementing these guidelines, and for ensuring that CRRT is delivered safely and effectively 2, 3.