Pulmonology Coding Alert

Question: I am looking for information regarding critical care coding. Would you please advise me on the criteria a visit needs to meet for me to report 30-74 minutes (99291)? Our pulmonologists are asking if both face-to-face discussions or telephone discussions with the other physicians seeing their patients can be counted as part of the time adding up to this critical care level.


Florida Subscriber

Answer: The adult critical care codes, 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]), are both time-based codes. The time for the patient includes the time for all activities the physician performs on the patient's unit/floor or in the patient's room that directly pertain to the care of the patient. This would include the time in the unit spent talking to consultants discussing the patient's care or telephone calls in the unit to consultants discussing the same.

Other activities in the ICU, such as reviewing laboratory data, reviewing x-rays and CT scans on a PACS system, reviewing monitoring data, and documenting this material in the medical record, are all considered critical care time. This time may also occur over several visits to the patient during the day.
 
If the patient is unable or clinically incompetent to participate in discussions about her care, then discussions with the family on the unit obtaining history, talking about the patient's condition, and discussing the prognosis or treatment are considered critical care.
 
Time spent off the unit looking at radiographs, answering phone calls, and discussing the patient with other consultants does not count as critical care time. To report the first hour of critical care services (99291), the physician must spend, and document, more than 30 minutes during one calendar day. The time you report must be the physician's personal time and should not overlap with any other physicians' visit(s).