General Surgery Coding Alert

Question: Is it appropriate to include the time that our PA spends with a patients spouse or children in determining critical care coding?

Iowa Subscriber

Answer: It depends on the nature of the conversations the PA has with these family members. Generally speaking, coders may assign critical care codes (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes; and +99292 each additional 30 minutes [list separately in addition to code for primary service]) only when the physician is engaged in work that is directly related to the patients care.

This time may be at bedside or elsewhere on the floor or unit. For example, it may include time spent reviewing test results or imaging studies, discussing care with other medical staff, or documenting critical care services in the medical record.

However, the CPT manual also states that critical care services may encompass time spent on the floor with the family members or surrogate decision-makers. These instances may be reported as critical care if the patient is unable or clinically incompetent to participate in these discussions. These discussions must have a direct bearing on the patients care and could include reviewing the patients condition or prognosis, obtaining a medical history, or discussing treatment options and treatment limits.

Telephone calls to family members and surrogate decisions-makers may be charged as critical care services if they meet the same conditions as face-to-face meetings. However, simply providing the family with regular updates on the patients condition, answering questions or providing emotional support do not fit the requirements for critical care services.