Reporting the critical care codes (99291-99292) can lead to mass confusion for many coders and billers. After all, these services are considered both inpatient care and E/M services — but they follow slightly different rules than most other inpatient E/M codes.
To get a handle on how to report the critical care codes at your practice, check out three key facts.
1. Critical Care Is Based Solely on Time
Unlike the other E/M codes, you can’t select critical care codes using medical decision-making (MDM), since all critical care services would be considered a high MDM level. Instead, you must select your critical care coding levels based on the time spent.
For the first 30 to 74 minutes managing the critically ill or critically injured patient, you’ll report 99291. For each additional 30 minutes thereafter, you’ll report a unit of 99292, which is an add-on code that can only be reported along with 99291.
2. Documentation Must Show Direct Patient Contact, Organ System Impairment
Critical illnesses or injuries are defined as those with impairments to one or more vital organ systems with an increased risk of rapid or imminent health deterioration. In addition, critical care requires direct patient-provider involvement in order to evaluate, control and support vital system functions and avoid further declines the patient’s condition.
Therefore, your medical record absolutely must include documentation of the vital organ system impairment and the provider’s direct care for the patient.
For instance, the notes might start with, “I personally evaluated Mr. Smith, and his lungs have continued to deteriorate since yesterday, with pulse ox at 77 even with the oxygen at six liters per minute. I called the on-call pulmonologist to discuss intubation and spent 66 minutes total between listening to Mr. Smith’s breath sounds, talking to other providers, reviewing lab results and staying at the patient’s bedside.”
3. The Provider Must Be Immediately Available
If you’re reporting critical care services for the physician’s time, the provider must be immediately available and should not be tending to other patients during the minutes that they count toward your patient’s care.
For instance, suppose your provider meets with a cardiologist to discuss two patients’ conditions. You first must carve out the time spent on patient A vs. patient B so you only count the time spent on each patient toward their critical care time. Plus, the doctors must have the conversation nearby and not in another building if one or both of them counts the time toward critical care. That’s because the provider must be immediately available to the patient to count the time.
For instance: Your provider meets with the cardiologist on the critical care unit, directly outside the patients’ rooms. He spends 18 minutes discussing patient A and 24 minutes discussing patient B. Although he spent a total of 42 minutes with the cardiologist, he cannot count the whole 42 minutes toward patient A and/or patient B. Instead, he must count 18 toward patient A’s time and 24 toward patient B’s time.
There are so many nuances to inpatient coding — let an expert help you collect for your hospital-based services. Dreama Sloan-Kelly MD, CCS, CPC can help during her online training, Improve Inpatient Coding (99221-99239) Accuracy & Reimbursement. Register today!
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