Urology Coding Alert

Question:

North Carolina Subscriber

No -- you can't bill critical care (99291-99292, Critical care, evaluation and management of the critically ill or critically injured patient ...) simply because the place of service is the intensive care unit (ICU).

The service you describe would be an inpatient consultation, such as 99253 (Inpatient consultation for a new or established patient ...). For Medicare or other payers not accepting consultation codes, this would constitute an initial hospital care code such as 99221 (Initial hospital care, per day, for the evaluation and management of a patient ...).

Critical distinction: Critical care is not location-based; rather, it describes a specific kind of care. You must meet the following criteria to bill for critical care:

Typically, the physician providing critical care monitors the patient for an extended time and obtains opinions and advice from multiple specialties (including urology) to create an overall care plan. In general, urological care rarely constitutes critical care and you'll bill critical care codes infrequently for urological services.