Shared critical care without duplicate minutes

Synthetic encounter and reporting party

Fictional patient: Victor Lane, age 79. Date: September 9, 2026. Dr. Mara Kent and nurse practitioner Alex Reed work in the same critical-care group at a hospital. The professional service is reported under Original Medicare. These details and the clinical course are invented.

Critical illness and current work

The treating clinicians document acute hypoxemic respiratory failure with an imminent risk of further respiratory deterioration. They provide intensive reassessment of oxygenation and respiratory effort, manage ventilatory support and review the response. The exercise stipulates that the full clinical record supports critical-care medical necessity and the qualifying service definition.

Physician alone: 13:00–13:35

Dr. Kent provides thirty-five minutes of qualifying critical care alone, assessing the acute respiratory threat, making management decisions and reassessing response. During the counted interval, the physician’s attention is devoted to this patient; no other patient service or separately reportable procedure is included.

Nurse practitioner alone: 13:35–13:55

Alex Reed provides twenty qualifying minutes alone, monitoring the response to the agreed management, reassessing the patient and documenting the findings. The interval begins after the physician-only interval and does not overlap it.

Joint interval: 13:55–14:05

The physician and nurse practitioner then spend ten qualifying minutes together at the bedside discussing the evolving findings and the management plan. This is one elapsed ten-minute interval, not two successive intervals. Neither clinician reports another patient’s work during it.

Documentation and billing review

Both practitioners are identified in the record. Their notes preserve the solo and joint intervals, with no separately reported procedure time included. The immediate exercise asks for unique combined critical-care time. The final claim still requires review of the substantive portion, billing practitioner’s signature/date and the applicable split/shared reporting requirements; the two names alone do not complete that review.

Your coding worksheet

1. Draw the three intervals on a time ledger.
2. Calculate the unique combined duration.
3. Explain why the shared interval is counted once.
4. Identify the additional substantive-portion and documentation review needed for billing.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.