Practice Management Alert

Master Critical Care With 3 Techniques

Time is crucial for reporting critical care services with 99291 and 99292, but the severity of the patient's condition is also an important criterion. Use these three steps to report critical care correctly every time:
 
1. Never assume you can code for critical care services just because the patient is in an intensive care unit (ICU) or critical care unit (CCU), says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver. The patient must be "critically ill or critically injured," according to CPT.
 
What to look for: The physician's documentation should state how the patient's condition is life- threatening. For example, documentation may state the patient went into cardiac arrest or respiratory failure, and needed to be put on a ventilator.

2. Report both critical care and another E/M service if necessary. Most payers, including Medicare, allow you to report only one E/M code for all the services a physician provides to the same patient on the same date of service - but critical care codes are the exception to this rule.
 
Modifier -25: If you report critical care along with another E/M code, correct coding dictates that you should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the other E/M code you report.

3. Use critical care codes "to report the total duration of time" a physician spends providing critical care, CPT states. And the time does not need to be continuous. Critical care services include both face-to-face patient time and time spent elsewhere on the floor or unit tending to the patient's care.