Critical care codes

Pat Liebl

Networker
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Does anyone know if a patient is in the critical unit for 5 days, The first day is billed a 99291, should the second day also be billed at a 99291 also or a 99233. We always keep billing the 99291 and never had any problem but now we are questioning if this is correct. Please someone advise Thank you Pat
 

thomas7331

True Blue
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Critical care codes are for urgent interventions when a patient is critically ill and the documentation has to support the code description (including time spent, high level MDM and the critical and urgent nature of the patient's condition. If the provider is just documenting daily visits to a patient in the critical care unit, the inpatient E&M may be more appropriate. Each note would have to be evaluated on its own merits to make the determination if it meets the definition of critical care or an other E&M service.
 

coloradopa

Networker
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Georgia
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Does anyone know if a patient is in the critical unit for 5 days, The first day is billed a 99291, should the second day also be billed at a 99291 also or a 99233. We always keep billing the 99291 and never had any problem but now we are questioning if this is correct. Please someone advise Thank you Pat

Critical care code 99291 is for the first 74 minutes of critical care.
To bill for critical care there is a three step process:
• The patient must be critically ill. This is defined as critical illness or injury that “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”
• The provider must treat the critical illness using “high complexity decision making to assess, manipulate, and support vital systems to treat single or multiple vital organ system failure and/or prevent further life threatening deterioration of the patient’s condition.” The care requires the personal attention of the provider. Care must be provided at the bedside or on the floor/unit where the patient is housed.
• Time must be documented and be over 30 minutes

If critical care totals more than 74 minutes, 99292 is used for each additional 30 minutes. For example a 120 minutes of critical care would be billed as 1 x 99291 and 2 x 99292.
Finally presence in an ICU does not mean the patient is critically ill. The patient must be assessed each day and if not critically ill, should be billed as the appropriate follow up E/M

Here is an article that describes things in more detail.
http://www.sccm.org/Communications/...Billing-Basics-Billing-for-Critical-Care.aspx
 
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