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Thread: Critical Care Charges

  1. #1
    Join Date
    Apr 2007

    Default Critical Care Charges

    AAPC: Back to School
    If a physician admits a patient in critical care and he treats the patient there for 3 hours what can be billed? Are we allowed to do an H&P 99221-99223 in addition to 99291 and 99292 on the same day?
    Thank you, Andi
    Andi M.

  2. #2

    Default Critical care

    Yes, you can bill them both out, however, remember that critical time is a "time CPT" so the provider has to state how long he was with the patient to be able to bill out critical care. So if you bill out an E/M 99223, which is 70 minutes and the provider has dictated that he was with the patient for 3 hours, then you would bill out the 99223-25 and 99291, 99292x2

    totally up the time,
    99223- 70 minutes
    99291 - 30-74 minutes
    99292x2 - 105-134 minutes

    Anytime that a time CPT is used, the provider has to dictate or handwrite the time that he was with the patient

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Was the care provided critical care?

    Just because the patient was in the intensive care unit does not mean that the physician provided the critical care.

    Also, if you are billing the initial hospital visit separately, any time spent in doing the admission CANNOT be counted towards critical care time (no double dipping).

    Personally, if the physician truly was providing critical care for 3 hours, I would just bill the 99291 and 99292(x 4) ... the reimbursement is higher.

    The documentation should indicate the critical nature of the patient's condition, the critical care provided, the total amount of face-to-face time (includes unit time in an inpatient setting).

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 01-21-2009 at 10:53 AM.

  4. #4
    Join Date
    Apr 2007

    Default One more question

    Debate in office....can you ever post a 99231-99233 along with 99291-99292?
    Thank you so much for your help.
    Andi M.

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Why would you want to?

    Many years ago I recall learning that yes, you might be able to do this. For example: you visit patient in the morning and patient is stable, but later in the day the patient codes and you spend 30 min or more in critical care.

    BUT ... I don't think anyone ever got paid for both services. If you do this, remember that any time you spend on the subsequent hospital visit CANNOT be counted towards the 30 minutes face-to-face time required to bill critical care.

    I wouldn't even go there unless my doctor was an exceptionally good documenter. It's just not worth it for $88 (reimbursement for 99233).

    F Tessa Bartels, CPC, CEMC

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