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Thread: Can CRITICAL CARE be coded?????

  1. #1

    Default Can CRITICAL CARE be coded?????

    AAPC: Back to School
    Doctor is called to consult in ICU and bills for 99291 CC. The doc ordered CT and to ordered to hydrate patient & states will monitor potassium levels & gives time of 38 minutes. The patient has a multitude of problems and doc states in chart prognosis is poor. Can the doc bill critical care?

  2. #2
    Join Date
    Apr 2007
    Duluth, Minnesota


    just from what you've written, I'd say no...doesn't meet the guidelines for coding/billing out critical care services, but there could be more to the documentation that you're not posting.

    Read up on the guidelines in the CPT book - page 18, 2009 professiona edition, AMA....
    Donna, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Maybe ...

    You start by saying the doctor was "called to consult." You may have a consultation. Just because the patient is in the ICU does not mean that your physician provided critical care.

    Read the guidelines for Critical Care in the CPT book carefully.

    The patient must be critically ill. The care provided must be critical care. The physician must provide at least 30 minutes of direct face-to-face critical care.

    You mention he is monitoring potassium. Hyperkalemia can be a critical condition. But I just don't have enough of the documentation to be able to give you a definitive answer.

    Hope that helps

    F Tessa Bartels, CPC, CEMC

  4. #4


    Thanks everyone, I believe it was a consult and have mention this to the doc.

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