Check Thresholds for Critical Care Code Reporting
Question: Two critical care providers saw a patient on the same day. I reported 99291 for “my” provider, as they spent 28 minutes with the patient. The documentation says that the other provider spent 40 minutes with the patient earlier in the day. Why was my claim denied? Texas Subscriber Answer: According to information available from the Medicare Learning Network (MLN) booklet Evaluation and Management Services, there are two potential issues here. Check out this table information from page 11: Situation Code to Report Key Points Critical care time with patients is 30-74 minutes (any time during the same day) 99291 Bill once per date, per patient Critical care time with patient is ≥ 104 minutes 99291 + 99292 99292 for each additional 30 minutes beyond initial 74 minutes Critical care time with patient is < 30 minutes Do NOT bill 99291 Doesn’t meet threshold Two of these situations seem to apply here. Two providers possibly — unless you know for certain that the other provider did so — tried to report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), but MLN says that code can be billed only once per date, per patient. Regardless of whether the other provider’s office reported 99291, MLN says that it would not be appropriate to bill 99291 in this situation. Your provider documented 28 minutes of time with the patient and therefore wouldn’t meet the threshold for reporting 99291. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
