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codes 99291 and 99292 when billed with 99232

  1. Default codes 99291 and 99292 when billed with 99232
    Medical Coding Books
    Good Morning...

    I am in question as to how to bill a 99291/99292 with a 99232. Wanting to know the guidelines on how/if we can bill these particular codes on the same DOS? Can someone help me with this question?


  2. #2
    99291 and 99292 are critical care E&M codes. When Patient is in critical care and the visit is under 30min you bill a regular Hospital visit. 99232 ETC. If the visit exceeded 30min - 74 min you bill 99291 if it goes over 74min you can also bill the add on code 99292 and so on. This visit are all time based You will find it in the cpt should be self explanatory You can not bill 99232 with 99291 and 99291

  3. Default 99291/99292 verses 99232
    Can you bill a 99291 on admission alone or do you need to bill a 99223 1st?
    Last edited by ctpope31; 09-02-2014 at 01:20 PM.

  4. Default critical care and subsequent care
    I code for several specialties..I found this helpful to answer that question.

    "When critical care services are provided on a date where an inpatient hospital, hospital
    emergency department, or office/outpatient evaluation and management service was
    furnished earlier on the same date at which time the patient did not require critical care,
    both the critical care and the previous evaluation and management service may be paid.
    Physicians are advised to submit documentation to support a claim when critical care is
    additionally reported on the same calendar date as when other evaluation and
    management services are provided to a patient by the same physician or physicians of the
    same specialty in a group practice. "

  5. #5
    Default Critical care and subsequent visit
    Yes you can bill all three, you need to append modifier 25

    A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date.

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