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Pulmonology Coding Alert

Reader Question:

Critical Care Codes

Published on Sat Sep 01, 2001

Question: Can 99291-99292 be used twice in the same day, provided the critical states are mutually exclusive? If not, is there a way to document separate instances of critical care?

Florida Subscriber
 
 Answer: Time is a major factor in reporting critical care services. Use 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]) to report the time a physician spends providing critical care services to a patient, even if the time spent is not continuous. For any given period of time spent providing critical care services, the physician must devote full attention to the patient and cannot provide services to another patient during the same time.  
 
The time is accumulated and reported per calendar day, regardless of the differing reasons for rendering critical care services throughout the day. 99291 represents the first 30-74 minutes of the day and can be reported only once per day. Code 99292 is reported for each additional 30 minutes of critical care on a given date of service.
 
For example, 75-104 minutes of critical care is reported as 99291, 99292. Critical care time of 105-134 minutes would be coded as 99291, 99292 x 2, etc. (see CPT 2001 critical care section for full chart). You must bill 99292 in increments of 30 minutes. Anything less than 30 minutes cannot be reported separately. Code 99291 can be used only once in a given day per doctor per patient.
 
-- Answers to You Be The Coder and Reader Questions provided by Walter ODonohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP; and Carol Pohlig RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania in Philadelphia.

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