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Internal Medicine Coding Alert

Quick Tips Revive Your Critical Care Claims

Published on Tue Feb 10, 2004

We'll show you how to capture $250 with 99291

Do you want to sort through the confusion that some internal medicine coders face when choosing between a level-five new patient code (99205) or critical care codes (99291-99292) for in-office anaphylaxis reaction treatment? The right answer could mean the difference between $250 for 99291 and $180 for 99205.

Review the following three quick tips to get your internist paid for critical care services.

  •  Know how to spot a critical-care patient. CPT defines a critical illness or injury as one that impairs one or more vital organ systems. This creates a high probability of imminent or life-threatening deterioration in the patient's condition.

    Example: A patient has a severe systemic reaction to an insect sting. If the condition becomes life- threatening, affects one or more of the patient's vital organ systems, and the physician provides direct medical care, critical care services may apply, says Diane M. Minard, CPC, a coding specialist for Dartmouth Hitchcock Medical Center in Lebanon, N.H.

     
  •  Remember that critical care involves high-complexity decision-making used to treat and evaluate vital system function(s). In critical care, the physician treats single or multiple vital organ system failure(s) and/or prevents further life-threatening deterioration of the patient's condition.

    Tip: The physician must continue these life-sustaining services, which do not have to occur at the patient's bed, for 30 minutes to qualify for 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). Using the above example, if the internist treats the patient for 45 minutes, you could assign 99291. If the doctor cared for the patient for 75 minutes, you could have used 99291 and +99292 (... each additional 30 minutes ...). But remember that if the total critical care time comes to less than 30 minutes, you should not use 99291-99292.

  •  Critical codes are not for hospital use only. Although the physician does not usually provide critical care services in the office for an extended time, he or she may perform them in the office until the patient can be transported to a hospital or critical care unit. In the above example, the physician treated the patient before sending him to the emergency department.

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