Reader Question: Admitted Patient Critical Care

Question: Can I charge the critical care code 99291 (critical care, evaluation and management of the critically ill or critically injured patient) if the patient is admitted from the emergency department to a unit requiring more care than a regular floor but not an intensive care unit? Can this code ever be reported with the evaluation and management (E/M) (99281-99285) codes?

Rebecca Bennett, RHIT
Heartland Regional Medical Center, St. Joseph, Mo.

Answer: Critical care should not be used in addition to the E/M-level codes (99281-99285). And yes, if you are admitting a patient to an ICU step-down unit, it is appropriate to assign critical care (based on your facilitys criteria). However, if you admit the patient to your facility, all the charges will be rolled into the DRG (diagnosis-related group) reimbursement.

- Published on 2001-04-01