Part B Insider (Multispecialty) Coding Alert

Question: Our physicians often perform critical care (99291-+99292) when they do rounds in the intensive care unit, but we are curious about whether we can bill these codes for services performed in a standard hospital room or in the office. Is that something we can bill with 99291?

Maryland Subscriber

Answer: Yes, you can report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) in the outpatient setting, as long as you meet the requirements of the code. The provider must be directly delivering medical care for a critically ill or critically injured patient and must meet the time thresholds to bill the code.

For example, suppose a patient is doing a six-minute walk test in your hallway and goes into cardiac arrest. The physician administers critical care services for 30 minutes until the EMTs place her in an ambulance to take her to the hospital. In this situation, you can report 99291, assuming that the documentation supports the code.

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