Urology Coding Alert

Question: Can we count my urologist's face-to-face discussions and/or telephone discussions with the other physicians about a patient when we determine a critical care level?


Florida Subscriber

Answer: You can consider the time your physician spends on telephone calls and discussions with other specialists as critical care time if those interactions take place on the patient's unit or floor.

The adult critical care codes 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]) are both time-based codes.

The time for the patient includes the time for all activities the physician performs on the patient's unit/floor or in the patient's room, which directly pertain to the care of the patient. This would include the time in the unit spent talking to consultants discussing the patient's care or telephone calls in the unit to consultants discussing the same.

You can count other activities in the ICU, such as reviewing laboratory data, reviewing x-rays and CT scans on a PACS system, reviewing monitoring data, and documenting this material in the medical record as critical care time. This time may also occur over several visits to the patient during the day.

If the patient is unable or clinically incompetent to participate in discussions about her care, you should consider discussions with the family on the unit obtaining history, talking about the patient's condition, discussing prognoses or treatment as critical care time.

You cannot count time your urologist spends off the unit looking at radiographs, answering phone calls, or discussing the patient with other consultants as critical care time. For you to report the first hour of critical care services (99291), the physician must spend, and document, more than 30 minutes during one calendar day.

If the urologist spends fewer than 30 minutes in critical care for a hospitalized patient, you would most likely use 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). The time you report must be the physician's personal time and should not overlap with any other physicians' visits. 

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.