# Critical Care-what is bundled



## flngub (May 30, 2014)

What is bundled in with Critical Care? I have found a couple different articles stating that EKG interpretation, pulse optometry, intubation are bundled. I also found some articles stating they are NOT bundled. Can anyone help? Is anything bundled in with critical care?


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## mssalemny (May 30, 2014)

good article link below but I find the CPT book to be the best reference.

http://www.acep.org/Legislation-and...s/Physician-Payment-Reform/Critical-Care-FAQ/


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## MarcusM (May 30, 2014)

http://www.todayshospitalist.com/index.php?b=articles_read&cnt=897

Procedures count 
There are services often performed during critical care that you can’t bill separately. However, the time spent performing these services counts toward your total critical care time. Those services include: 

gastric intubation (43752, 91105);
interpretation of blood gases and interpretation of data stored in computers, such as ECGs, blood pressure, hematologic data (99090);
interpretation of cardiac output (93561-93562);
interpretation of chest X-rays (71010-71020);
pulse oximetry (94760-94762);
temporary transcutaneous pacing (92953);
vascular access procedures (36000, 36410, 36415, 36591, 36600); and
ventilator management (94002-94004, 94660, 94662).

Any other services that aren’t on this list—such as placing central lines or chest tubes, doing endotracheal intubations, and performing CPR—may be billed separately. The time you spend performing these other services, however, can’t be included in your total critical care time. Be sure to document that the critical care time you’re billing does not include the performance of a separately billable service or procedure. 

The 30-minute issue
Then there’s this question: How much of “each additional 30 minutes” must you perform to be able to bill a 99292? CPT guidelines state that you need to spend at least 75 minutes to report both 99291 (for initial critical care) and 99292 for the additional 30 minutes. 

However, there is some controversy about reporting code 99292 when the amount of time you spend beyond the initial 74 minutes is less than 15 minutes. Check with your carriers, but when billing Medicare, I recommend using the more conservative approach and billing 99292 only if you have performed 15 minutes beyond the initial 74-minute time frame. Also remember that CPT code 99292 should be reported in addition to 99291 when billing for that additional time. 

As for critical care services that take less than 30 total minutes, you’re at a disadvantage because you cannot bill them using a critical care code. Instead, bill such services with an acute care evaluation and management (E/M) code. 

Keep in mind that Medicare does allow you to bill both critical care codes and an inpatient hospital service performed on the same day, if the patient becomes critical after the inpatient hospital care has been rendered. 

Finally, if you do not document the total time spent providing critical care, your record will not support the use of critical care codes. In such cases, your bill may be denied or downcoded to an acute care E/M code. - See more at: http://www.todayshospitalist.com/index.php?b=articles_read&cnt=897#sthash.0XeDaITq.dpuf


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## flngub (Jun 2, 2014)

Thank you


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## rthames052006 (Jun 5, 2014)

flngub said:


> What is bundled in with Critical Care? I have found a couple different articles stating that EKG interpretation, pulse optometry, intubation are bundled. I also found some articles stating they are NOT bundled. Can anyone help? Is anything bundled in with critical care?



Your CPT book has a listing of all items/services that are included in critical care directly under the Critical Care description.  Great reference and as another poster commented, check with CMS as well.  

I just listened in on a great teleconference my local MAC presented this week and as I always say, if I learn 1 thing I feel like I'm "winning"!


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## MarcusM (Jun 5, 2014)

Rock on, Roxanne....I am in the same boat as you...I had a doctor tell me one time that I always found something beneficial no matter how bad a meeting was....call me the optimist who is happy in a room full of horse manure, shoveling to the bottom to find the pony....


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## rthames052006 (Jun 6, 2014)

MarcusM said:


> Rock on, Roxanne....I am in the same boat as you...I had a doctor tell me one time that I always found something beneficial no matter how bad a meeting was....call me the optimist who is happy in a room full of horse manure, shoveling to the bottom to find the pony....



I love your analogy there Marcus! Keep shoveling !

Have a great weekend!


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