ED Coding and Reimbursement Alert

Some recommend a '15-minute rule' on critical care add-on.

When providing critical care, the ED physician might perform extended critical care that allows you to report 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]).

If you report +99292, you'll add about $110 to your claim (2.99 transitioned facility relative value units [RVUs] multiplied by the Medicare conversion rate of 36.8729.).

Caveat: Even though you can technically report +99292 for even a single minute of critical care past 74, there is a chance the payer won't accept it. Greer Contreras, CPC, senior director of coding for Marina Medical Billing Service Inc.

in California, recommends coding +99292 for 15 minutes or more of critical care past the initial 74; meaning a critical care session must last 89 minutes before she would report 99291 and +99292.

Others aren't so sure. Michael Lemanski, MD, ED billing director at Baystate Medical Center in Springfield, Mass., endorses accounting for all the critical care minutes exactly and coding based on that number.

"By definition, 99291 represents 30-74 minutes of critical care. Consequently, 75 minutes of critical care should be reported as 99291 and +99292," he explains.

Best bet: Check with your insurer, or your physician, before deciding how to approach using +99292.