Internal Medicine Coding Alert

Question: Our physician provided 100 minutes of critical care to a patient, but the encounter did not take place in the critical care unit; the internist treated the patient in an observation unit. Can I still report critical care for this session?

Texas Subscriber

Answer: Yes, you can report critical care codes for this service. On the claim,

 • report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 74 minutes of critical care.

 • report +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) for the ensuing 26 minutes of critical care.

Explanation: When you're deciding whether your internist provided critical care, the patient's condition, not the place of service, determines whether you can report 99291 and 99292. In addition to traditional critical care settings (emergency department, intensive care unit, etc.), the internist can perform critical care in the observation unit, or the medical surgical floor, or anywhere else.

According to the Medicare Claims Processing Manual, "critical care is usually, but not always, given in a critical care area ... However, payment may be made for critical care services provided in any location as long as the care provided meets the definition of critical care." 

Remember that your documentation must prove that the patient was critically ill and that minimum time thresholds were met. Also, keep in mind that 99292 is an add-on code, meaning that you cannot report it without also reporting 99291.

 -- Answers to You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, director of government program services for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.