General Surgery Coding Alert

Question: When our surgeon rounds on a patient in the critical care unit, can we use the critical care E/M codes for the encounter?

Nebraska Subscriber

Answer: No. To use the critical care codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and, if needed, +99292 (… each additional 30 minutes (List separately in addition to code for primary service)), the service must occur when the service is required, not conveniently on rounds. Being in the critical care unit does not necessarily warrant a critical care code.

To use the critical care codes, the patient must be critically ill or injured, requiring urgent care for a life-threatening condition. Also, the physician must use high-complexity decision making to address the condition, and the service must be at least 30 minutes within the same day. During that time the physician must be available to the patient and engaged directly with the patient’s care.