Pain Management Coding Alert

Published on Wed Mar 08, 2017 PDF

Question: If the physician meets the requirements for critical care and has spent one full hour with the patient, how would I properly code this encounter?

Alaska Subscriber

Answer: You would use only 99291 (Critical care,  evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) in this situation.

Critical care occurs when a physician or other qualified healthcare professional directly provides medical services for a critically ill or critically injured patient. The physician usually provides critical care services in a critical care area like the ICU, CCU, or emergency room. As always, the documentation must support the necessity of the critical care service.

To qualify for critical care, a service must meet the following requirements:

• The patient must be critically ill/injured - have vital organ failure or a life-threatening health condition.
• The physician must perform the critical care services, including using high-complexity decision making to assess, manipulate, and support vital system functions to treat vital organ system failure or to prevent further life-threatening conditions.
• All critical care services must last at least 30 minutes on a given date of service. The time can be continuous or intermittent. But, for any given period of time the physician spends providing critical care services for a patient, he cannot provide services to any other patient during the same period of time.

Note: You can use 99291 only once per date.