Gastroenterology Coding Alert

The new CPT 2000 has made extensive changes to its critical care evaluation and management (E/M) services area. These changes mean billing for time the physician spends providing critical care for patients, including time spent directly with the patient, working on the patients case, and with the patients family.

The new CPT defines the critical care codes as:

99291critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292each additional 30 minutes (list separately in addition to code for primary service)

Specific Time Limits Set

The new definition of code 99291 sets the specific duration for the initial E/M service at 30 to 74 minutes.

Additional time spent with the patient can be billed in 30 minute increments using code 99292. The 1999 requirements that the patient be unstable and require constant attendance from the physician have been deleted.
These changes mean that critical care that takes less than 30 minutes in total duration is no longer coded as 99232 or 99233 (subsequent hospital care).

Such services can be reported with an appropriate E/M code. If a patient is not critically illbut happens to be in a critical care unitthe physician may not use the critical care code, but should use the appropriate E/M code. Therefore, if a physician is not devoting his or her full attention to the patient, the service cannot be classified as critical careeven though the patient is in the critical care ward.

Critical care services in CPT 2000 now include, but are not limited to, the treatment or prevention or further deterioration of central nervous system failure; circulatory failure; shock-like conditions; renal, hepatic, metabolic or respiratory failure; postoperative complications; or overwhelming infection. The physician may be required to do extensive interpretation of multiple databases and to apply advanced technology to manage the patient.

Time Spent With Patient to Be Reported

The notes on critical care evaluation and management in CPT 2000 state that for a given period of time to qualify as a critical care service, the physician cannot provide services to any other patient so that his or her attention is focused on the critically ill patient.

But time spent both at the patients bedside and elsewhere in the critical care unit can be reported as critical care. Time spent elsewhere in the unit must contribute directly to the treatment of the patient and can include activities such as reviewing test results or discussing the treatment with other members of the medical staff.

Time spent on the floor with family members or surrogate decision-makers when the patient is clinically incompetent to participate in discussions also may be reported as critical care, provided that the conversation is focused on medical decision-making.

Because the physician is not immediately available to the patient, a physicians time spent on activities that occur outside the unit may not be reported as critical care.

Also, activities that do not contribute directly to the critically ill patients treatment, such as administrative meetings or calls to other patients, cannot be reported as critical care even if they are performed in the critical care unit.