Interestingly enough the January 2009 Coding Edge magazine has an article about Critical Care Coding written by Elin Baklid-Kunz. On page 18 the table that is printed in CPT and that is part of the Medicare guidelines that are so at issue is printed ... 75 - 104 minutes equals 99291 x 1 plus 99292 x 1.I would like to thank everyone for their discussion on this topic and providing their sources. Our expert advisors are split on the proper code selection. Below is a summary of information from CMS, CPT Assistant and the CPT manual.
According to 100-04 Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners 30.6.12 - Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)
â€śThe CPT code 99291 is used to report the first 30 - 74 minutes of critical care on a given calendar date of service. It should only be used once per calendar date per patient by the same physician or physician group of the same specialty. CPT code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care (See table below-the same as in CPTÂ®). Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the critical care codes. This service should be reported using another appropriate E/M code such as subsequent hospital care.
The same information is also provided in the revised transmittal which notes an error provided in the 1530 Transmittal regarding critical care time.
The most recent information provided by CMS supports using 99291, 99292 for 75 minutes of critical care time.
The information provided in CPT Assistant is as follows:
November 1999 CPT 2000 Code and Guideline Changes: A Comprehensive Review
â€śCode 99292 is used to report each additional 30 minutes beyond the first 74 minutes. It also may be used to report the final 15-30 minutes of critical care on a given date. Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not reported separately.â€ť
December 1998 Critical Care Services
â€śCPT code 99292 is used to report each additional 30 minutes beyond the first hour. It also may be used to report the final 15-30 minutes of critical care on a given date. Critical care of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.â€ť
The most recent information provided in CPT Assistant supports coding 99291 for 75 minutes of critical care. This is not reflected in the table provided in CPT.
The coding guidelines in CPTÂ® state â€śCode 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes.â€ť This would support coding 99291, 99292 for 75 minutes of critical care time since the clarification for 15 minutes is not provided.
We will request clarification from CMS and AMA.
Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC
Director of Exam Content
American Academy of Professional Coders
F Tessa Bartels, CPC, CEMC
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