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Topics in Practice Management |

Integrating Advanced Practice Providers Into Medical Critical Care TeamsAdvanced Practice Providers and Critical Care

Christine McCarthy, MBA; Nancy C. O’Rourke, MSN, ACNP; J. Mark Madison, MD, FCCP
Author and Funding Information

From the Children’s Hospital Boston (Ms McCarthy), Boston, MA; American Academy of Nurse Practitioners (Ms O’Rourke), Hollis, NH; and Division of Pulmonary, Allergy and Critical Care Medicine (Dr Madison), University of Massachusetts Medical School, Worcester, MA.

Correspondence to: J. Mark Madison, MD, FCCP. Pulmonary, Allergy and Critical Care Medicine, UMass Medical School, 55 Lake Ave N, Worcester, MA 01655; e-mail: mark.madison@umassmed.edu


For editorial comment see page 594

For related article see page 851

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):847-850. doi:10.1378/chest.12-0722
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Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP’s scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.


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