General Surgery Coding Alert

Question: I-m confused by the time requirements for reporting critical care services (99291-99292), as well as the minimum time required to report these codes. Help?


Texas Subscriber

Answer: The minimum critical care time required to report critical care codes 99291-99292 is 30 minutes.

Best strategy: Check the physician's documented total critical care time per date of service and select the correct units of 99291 and 99292 based on this chart:

Tip: For critical care time lasting longer than the examples listed here, simply add one unit of 99292 for each additional 30 minutes in the same manner illustrated in the chart. You qualify for -each additional 30 minutes- after the physician has spent and documented at least 15 minutes of critical care service.

Example: In the hospital, the physician tends to a patient experiencing shock. In this case the surgeon is able to stabilize the patient in 25 minutes, after which the patient is no longer in immediate life-threatening danger.

Because the critical care did not extend to 30 minutes or beyond, you should choose an inpatient visit (for example, 99223, Initial hospital care, per day ...) rather than 99291.

Important: The time the physician may count toward critical care need not be contiguous (in other words, uninterrupted). Rather, you should add together all the critical care for a given date of service to arrive at a cumulative total.
 
Example: If the physician provides one hour of critical care to stabilize the patient, but the patient's condition deteriorates later that same day and the physician must provide another hour of service, you may report 99291 (for the first hour) and 99292 x 2 (for the remaining hour), even though the services were not -back to back.-

You may count toward critical care the time spent -engaged in work directly related to the individual patient's care whether that time was spent at the immediate bedside or elsewhere on the floor or unit,- according to CPT.

For instance: Time the physician spends reviewing tests or discussing the patient's condition with other staff, documenting critical care services, or gathering information from family or surrogate decision-makers when the patient is unable to participate in discussions may count toward critical care, even though these activities may not occur at the patient's bedside.

The physician must document any time spent engaged in activities that do not take place at the patient's bedside (speaking with surrogate decision-makers, for instance) for such activities to count toward critical care.

You may not count toward critical care time:

- Services not related to the organ system or condition that requires critical care

- Any services that the reporting physician -delegates- to other healthcare professionals, including residents, nurses and other nonphysician practitioners

- Time spent outside the patient's unit or floor. If the physician is not immediately available to attend to the patient, he is not providing critical care

- Time spent updating the patient's family/surrogate decision-maker on the patient's condition

- Time spent providing any separately billable procedures: You should subtract from the total critical care time any time the physician spends performing separately billable services

- Any activities that do not directly contribute to the patient's care

- Time spent teaching residents or medical students.