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Thread: Help w/ 99291 without critical Dx

  1. #1

    Default Help w/ 99291 without critical Dx

    AAPC: Back to School
    I wondered if you could help me with a coding issue that I am having. I have a new physician that is a trauma surgeon. He is giving me paperwork that states Critical Care Time 1:32 and the Dx is Auto accident, concussion. I don't see that Concussion is a critical care Dx. He said he thought that patients seen in the trauma bay are all critical care regardless of their Dx. Can that be true? I'll admit, I've only coded Critical Care as in-patient and perhaps the trauma unit works differently? For inpatient I use 99291 with system failure such as resp failure 518.81. Can I bill 99291 with concussion code 850 even though it's not a MCC code. Maybe he's correct and POS 23 vs. 21 is the difference...... Can you help?

  2. #2


    Critical care in for a Trauma is no different than Inpatient. A person may be classified as a Trauma alert in the field, but once they have been evaluated by the Trauma doc, their diagnosis may not be critical. You still have to follow the Critical Care guidelines as stated in CPT. Just because they are a Trauma doesn't mean they are critical.

  3. #3


    Thank you, thats sort of what I thought but wanted to be sure. Would you agree that if they do not fall within the critical guidelines that they would code a 99222 ?

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Patient MUST be critically ill

    In order to use the critical care codes:
    1) A patient MUST be critically ill
    2) Critical care MUST be provided
    3) Face-to-face time must be recorded (minimum 30 minutes)

    A patient who is alert, talking, in no apparent distress following an auto accident ... even with a concussion ... is not critically ill, and therefore, the physician cannot code 99291-99292, regardless of time spent.

    Code the note based on documented level of service.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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