99291 coding/time factor

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Hello all,

I am trying to clarify the proper use of the 99291 for Critical Care E&M billing. My example would be: If the doctor meets the requirements for critical care billing and has spent 1 full hour with the patient in this regard - how would this be properly coded for billing purposes? I am thinking that just billing a 99291 would be appropriate because it covers the first 30-74 minutes. There is also the thought process that we should bill the E&M code; say 99233 (for inpatient situation) for the first 30 minutes along with the 99291 for the next 30 minutes. I need to know which is correct. Thanks!
 

espressoguy

Expert
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Tacoma, WA
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In your example you would only bill 99291.

The only time you would be able to bill both 9922x and 99291 would be if the provider initially saw the patient and billed 9922x and then later in the day the patient crashed and required critical care.
 

Mary Colleen Mescall

New
Local Chapter Officer
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Richmond
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Hi, I agree with espressoguy only use code 99291, you would only code an additional E&M when an inpatient or office outpatient evaluation and management service that was furnished earlier on the same dates at which the patient did not require critical care. you can locate the guidelines on the CMS website online manuals chapter 12 section 30.6.12 H

Colleen M.
 
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