Primary Care Coding Alert

Question: One of our providers spent 40 minutes treating a critically ill adult patient in a local hospital before returning to the practice. Later that same day, another, different provider from our practice treated the same critically ill patient for 50 minutes. Both providers practice in the same specialty (family practice). What is the correct way to bill for this?

California Subscriber

Answer: If your patient meets the criteria for critical care (a condition that “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration … [such as] central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure” according to CPT^®), then you can use 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), using add-on code +99292 (… each additional 30 minutes (List separately in addition to code for primary service)) for each additional half hour.

You can then go ahead and add up the minutes both physicians spent in critical care as if the two were one single provider. That’s because both physicians are of the same specialty, operating out of the same practice, and administering the same service on the same day.

In this case, the cumulative time the providers spent administering critical care to the patient is 90 minutes, meaning you can bill 99291 and +99292, as the total time is within the 75-104 minute range where it’s appropriate to report for 99291/+99292.

Coding caution: Remember, you can only use 99291 once per day. Additional time beyond 74 minutes is reported using an appropriate number of units of +99292.