Cardiology Coding Alert

Question: I am not sure how to code this critical care scenario. Physician A spent 30 minutes with the patient, Physician B spent 20 minutes, and Physician C spent 25 minutes. The physicians are all with the same practice and specialty. When I added the times together, I coded 99291 and +99292 (total time = 75 minutes). However, my office manager disagreed with the codes I submitted. He thought we should report 99291 and +99292 x 2 (one code for each person) instead. His reasoning was that we cannot add the two times together unless one of the physicians has spent a minimum of 60 minutes with the patient. He also said that if the first physician does not see the patient for 60 minutes, a 99291 would be billed for him and a +99292 would be billed for the second physician even if the two times added together do not equal more than 74 minutes. Can you advise us on this?

Maine Subscriber

Answer: When your physician provides critical care, the primary code you would report is 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). You will report this code only once for a patient in a day even if the services have been provided by one physician or more of the same group. For additional time, you will report multiple units of +99292 (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes [List separately in addition to code for primary service]) depending on the amount of time that was spent on providing critical care services.

To report either of these codes, you must meet the minimum defined time. Therefore, to code 99291, your physician(s) must have provided critical care for at least 30 minutes. In order to code the +99292 for each additional 30 minutes, you again must meet this code at a minimum of 15 minutes beyond the first hour.

The example that you have provided has three physicians providing critical care services for a total of 75 minutes. So, you will have to report one unit of 99291 (for the cumulative 60 minutes of initial critical care) and one unit of +99292 (for the next 15 minutes of critical care). Therefore, you are right in the way you have reported the services, and your office manager is incorrect.

Since the three physicians are part of the same group and specialty, they would report their cumulative service as if they were a single physician. The claim can be submitted under the first physician’s ID to satisfy the requirements for the first hour of critical care.