Description:
Concurrent care consists of treatment of one or more diseases or areas when those services are more extensive than consultative services and are rendered by more than one clinician during a period of time or during the same hospital admission, or medical and surgical care are rendered by the same clinician during the same admission.

Policy Statement:
Medical to Medical Concurrent Care:
Exists when two or more clinicians provide inpatient medical care to the same patient at the same time. Although each clinician is actively involved in providing care for a condition within his specialty, the attending clinician is responsible for coordinating the overall care of that patient.

If clincians of the same specialty or similar specialties render care for the condition at the same time, benefits will be provided ONLY for the attending clinician.

When two clinicians render care for unrelated conditions at the same time, benefits are provided to each clinician if:

                 (1) The clinicians are not of the same or similar specialty (e.g., endocrinologist and cardiologist).

                 (2) Each clinician is treating the patient for a condition unique to his or her specialty.

When the admitting clinician releases care of the patient to a consulting clinician and supporting documentation is provided.

Medical to Surgical Concurrent Care by Different Clinicians:
Benefits are provided for inpatient medical services performed by a clinician other than the admitting surgeon in addition to benefits for inpatient surgical services under the following circumstances:

• The medical care rendered was not related to the condition causing the surgery and is not part of a routine preoperative or postoperative care.
• The medical care required skills that are not possessed by the admitting or assisting clinician.
• A clinician other than a surgeon admits the patient for medical treatment and surgery becomes necessary.

Cardiac Procedures and Concurrent Medical Care:

• Benefits will be allowed to both the cardiac surgeon performing the cardiac procedure (e.g., coronary artery bypass, insertion of a pacemaker, etc.) and the attending clinician who renders the medical care UNLESS the cardiac surgeon takes charge of the medical and surgical care simultaneously.

Medical Care Benefits

• Benefits will be provided for the level of care carrying the highest allowable charge (PIMS) when a physician files for more than one level of care for services rendered to a patient on the same date of service.
• Skilled nursing facility visits are limited to one visit per week UNLESS supporting medical justification is supplied.
• Any medical treatment and services provided during evaluation and management services, such as blood pressure readings, a temperature reading, weight monitoring, fetal non-stress test, removal of cerumen, a dip stick urinalysis, pulse oximetry, interpretation and report of lab reports, interpretation and report of electrocardiograms (EKG), etc. are considered to be an integral part of the evaluation and management service and, therefore, not reimbursed as a separate entity.

Approved clinicians who may bill for services are listed below:

Physician

Nurse practitioner

Physician assistant

Clinical nurse specialist

Clinical psychologist

Clinical social worker

Licensed professional counselor

Licensed marriage and family therapist

Physical therapist

Occupational therapist

Speech therapist

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

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