Wiki Critical Care Time threshold on 99292

[LYDIA123]

Looking for input regarding the Critical Care time threshold? 75 min of critical care time should be billed as 99291, because the guideline states that Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not separately payable. Others interpert that 75 min should be billed as 99291 and 99292. Agree or Disagree???

The CPT code 99291 is used to report the first 30 - 74 minutes of critical care on a given calendar date of service. It should only be used once per calendar date per patient by the same physician or physician group of the same specialty. CPT code 99292 is used to report each additional 30 minutes beyond the first 74 minutes of critical care. It may also be used to report the final 15 - 30 minutes of critical are on a given date. Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not separately payable. Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the critical care codes. This service should be reported using another appropriate E/M code such as subsequent hospital care

 

[Naveen Rachagolla]

Looking for input regarding the Critical Care time threshold? 75 min of critical care time should be billed as 99291, because the guideline states that Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not separately payable. Others interpert that 75 min should be billed as 99291 and 99292. Agree or Disagree???

The CPT code 99291 is used to report the first 30 - 74 minutes of critical care on a given calendar date of service. It should only be used once per calendar date per patient by the same physician or physician group of the same specialty. CPT code 99292 is used to report each additional 30 minutes beyond the first 74 minutes of critical care. It may also be used to report the final 15 - 30 minutes of critical are on a given date. Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not separately payable. Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the critical care codes. This service should be reported using another appropriate E/M code such as subsequent hospital care

I would say that the appropriate code for 75 minutes of critical care is 99291 and 99292 Because:

1) I dint find anywhere in AMA CPT 2013 book regarding the threshold of time for 99292 is 15 minutes.
2) Even i tried to find in claims processing manual chapter 12 section 30.6.12 regarding the threshold of time for 99292 is 15 minutes.
3) At present iam preparing for CEMC exam, for that i purchased online practice exam from AAPC among those charts a question was asked......If this patient later became critically ill and her nephrologist subsequently spent 75 minutes bedside providing life supporting activities, what code(s) would be appropriate by the nephrologist?

the options for this question were A) 99291, B) 99292, C) 99291, 99292, D) None of the above.

The correct answer what they have given is option C with Rationale stating...Code 99291 reports the 30-74 minutes of critical care time. Code 99292 reports additional block(s) of time of up to 30 minutes each beyond the first 74 minutes. Refer to the table in the CPT® manual for determining critical care time