ED Coding and Reimbursement Alert

Question: The ED physician spent a lot of time and energy treating a patient, whom he eventually admitted to the ICU. The patient seems to meet the definition of critical care. The doctor is under the impression that he must spend 60 minutes with the patient to report critical care, because he thinks the first 30 minutes can't be included. Is this correct?


New Jersey Subscriber  
Answer: CPT instructs you to report critical care (99291-99292) for patients in -high probability of imminent or life-threatening deterioration- when the physician provides at least 30 minutes of care.

For fewer than 30 minutes of care of the critically ill patient, you should opt instead for the appropriate evaluation and management code (usually 99285,  Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status ...).