Anesthesia Coding Alert

Question: We have an intensivist who sees patients on the PICU floor, then puts the patients to sleep later for MRI. I have read the guidelines in the CPT^® book for critical care, but haven't seen a mention of anesthesia. Can we charge critical care and anesthesia on the same day by the same provider?

California Subscriber

Answer: Yes, critical care can be billed by an anesthesiologist (not a CRNA). However, the patient must meet the critical care criteria and the same documentation requirements apply to the anesthesiologist as any other provider. In addition, the critical care service must be rendered outside of the anesthesia time and pre- and postoperative care services routinely performed by the anesthesiologist.

Three criteria must be met before billing for critical care services: 

• The patient must meet the definition of critically ill/injured (vital organ failure; life-threatening health condition) 
• The physician must perform the critical care service >
• The critical care service must span a cumulative time of at least 30 minutes on a given date of service; any critical service provided for less than 30 minutes should be billed with the appropriate E/M code.

If the situation and the anesthesiologist's documentation meet critical care criteria, you'll report these codes, based on the amount of time involved: 

• 99291 – Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
• +99292 – ... each additional 30 minutes (List separately in addition to code for primary service).