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Thread: Critical Care Facility Coding

  1. #1

    Unhappy Critical Care Facility Coding

    AAPC: Back to School
    If a physician provides critical care services to a patient in the emergency room and bills for critical care would it be considered down coding if the facility level is billed only as a 99285 for that same visit?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The facility E&M levels do not have to match the physician's. So if the facility criteria says it is a 99285 then that is ok.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007

    Default Critical Care Facility Coding

    I am a new coder doing facility coding for the Hospital Emergency Dept. I'm looking for more information on this topic. What parameters do you use to decide whether to use 99285 or 99291?

  4. #4
    Join Date
    Apr 2007
    Bangor, Maine


    I think critical care coding is only for the professional side as it is a time-based code that is calculated by how much time the physician spends one-on-one with the patient. You can go on the ACEP (American College of Emergency Physicians) and look there for critical care coding information. They are a great resource for emergency roon coding.

  5. #5


    The fac. can code for the critical care but you have to make sure more then 30 mins of critical care is giving.

  6. #6
    Join Date
    Apr 2007
    Hannibal Missouri Chapter


    Could you tell me what guidelines you use for your ED facility coding? Are they based on ACEP? Are they specific to your facility?
    Brenda Emrick, CPC-H

  7. #7

    Default Critial Care Coding

    In the 2008 OPPS final rule, CMS again stated that hospitals must provide a minimum of 30minutes of critical care services in order to report CPT code 99291, Critical care evaluation and management of the critically ill or critically injured patient; first 30–74 minutes. The response to CMS frequently asked question 8809 states that hospitals must follow the CPT instructions related to CPT code 99291. Any services that CPT indicates are included in the reporting of CPT code 99291 should not be billed separately by the hospital.

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