Orthopedic Coding Alert

Question: I am new to coding. Can you help me understand what constitutes as critical care? Also, I once read that there is a specific list of services bundled into 99291, but I don’t remember what they are.

West Virginia Subscriber

Answer: 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)), occurs when a physician or other qualified healthcare professional directly provides medical services for a critically ill or critically injured patient. As always, the documentation must support the necessity of the critical care service. To qualify for critical care, a service must meet the following requirements:

• The patient must be critically ill/injured — have vital organ failure or a life-threatening health condition.
• The physician must perform the critical care services, including using high-complexity decision making to assess, manipulate, and support vital system functions to treat vital organ system failure or to prevent further life-threatening conditions.
• All critical care services must last at least 30 minutes on a given date of service. The time can be continuous or intermittent. But, for any given period of time the physician spends providing critical care services for a patient, he cannot provide services to any other patient during the same period of time.

Don’t miss: You cannot report time the physician spends in activities that occur outside of the unit or off the floor as critical care since the physician is not immediately available to the patient. Additionally, you may not report time spent in activities that do not directly contribute to the treatment of the patient as critical care, even if they are performed in the critical care unit.

The CPT^® critical care guidelines includes a specific list of services that are bundled into code 99291 that you should not report separately. These include the following:

• The interpretation of cardiac output measurements (93561, 93562);
• Pulse oximetry (94760- 94761, 94762);
• Chest x-rays, professional component (71045, 71046);
• Gastric intubation (43752-43753);
• Temporary transcutaneous pacing (92953);
• Ventilator management (94002-94004, 94660, 94662); and
• Vascular access procedures (36000, 36410, 36415, 36591, 36600).

Don’t miss: When your physician provides any of the above services during a critical care session, do not report them separately.