Pulmonology Coding Alert

Critical care patients no longer need always be considered unstable critically ill or unstable critically injured under CPTs revised critical care codes (99291-99292).

Lynne Marcus, vice-president of membership and public affairs, the American College of Chest Physicians, says, We removed the word unstable because we felt [the patient] could still be critically ill and have some stable values that come through, says Marcus, who was on the team involved in revising the codes definitions for CPT 2000.

Marcus says that the CPT 1999 definitions proved confusing for carrier medical directors, some of whom were not interpreting critical care definitions in a way that would be most beneficial to our patients. The goal in revising the language for the CPT 2000 manual was to clarify what critical care and intensive care are so that any carrier medical director could pick up this definition, she explains.

Understand the Difference Between 1999 and 2000 CPT

The revised definition says critical care services are the direct delivery by a physician(s) of medical care for a critically ill or injured patient.

The Critical Care Working Group, which comprises of representatives from six national specialty groups, worked with the Health Care Financing Administration (HCFA) to clarify the critical care definition.

The revision marks a significant change from CPT 1999 in the definition of critical care for the codes 99291-99292. Previously, CPT 1999 codes 99291 (first hour defined between 30 minutes-74 minutes) and 99292 (each subsequent 30-minute period) were used for the critical care, evaluation and management of the unstable critically ill or unstable critically injured patient who required constant physician attendance.

Use the critical care codes 99291 and 99292 to report the total duration of time spent by a physician providing critical care services to a critically ill or critically injured patient, even if the time spent by the physician on that date is not continuous. For any given period of time spent providing critical care services, the physician must devote his or her full attention to the patient and, therefore, cannot provide services to any other patient during the same period of time.

Marcus says the new critical care definition also reflects a wording change from constant attention to full attention, a change predicated on the working groups belief that you wont always be at the bedside, but youre still spending time taking care of that patient. We felt those were really important. According to the new definition, The physician need not be constantly at bedside per se but is engaged in physician work directly related to the individual patients care.

Tracking Time is Key

According to CPT 2000, the time spent with the individual patient should be recorded in the patients record. [...]