Anesthesia Coding Alert

Question: Can we charge for critical care and anesthesia on the same day by the same provider? We have intensivists that see patients on the PICU floor and then later on they put the patient under for MRI. I have read the guidelines in the CPT^® book for critical care but found nothing about anesthesia. Any help would be appreciated.

Virginia Subscriber

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

Your critical care code choices are:

• 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).

Critical care services include the treatment of vital organ failure or prevention of further life-threatening conditions. The presence of a patient in an ICU or use of ventilation is not sufficient to bill a critical care service. The following three criteria must be met for reporting critical care services:

• The severity of illness
• The intensity of services required to treat the illness
• The time spent in providing the care.

Proper documentation showing the medical necessity for providing critical care services is an absolute requirement. Most critical care service is provided to a patient in a “critical care area” such as the coronary care unit (CCU), intensive care unit (ICU), respiratory care unit, or emergency room.