DRG Coding Advisor: Time must be devoted for critical care codes

CPT codes 99291 and 99292 are used to report critical care services. But what is sometimes overlooked is that physicians billing for critical care must have devoted their full attention to the patient. Consequently, they cannot bill for evaluating or managing any other patient during the same time period.

The physician must report the time period she or he spent working on the critical care patient’s case. This time can be spent at the patient’s bedside or on the hospital floor, as long as the doctor is immediately available to the patient. However, any time spent outside the patient’s unit or floor, such as when taking telephone calls, cannot be billed as critical care.

To report services for a patient who is not critically ill but happens to be in critical care, intensive care, or another specialized care unit, use subsequent hospital codes (99231) or hospital consultation codes (99251-99263). Use code 99291 for the first hour of critical care provided on a given date.

Report the code only once per date, even if the physician has to break up the visit into separate parts. Critical care totaling less than 30 minutes on a given date should be reported using the appropriate evaluation and management code.

Use code 99292 to report each additional 30 minutes of care beyond the first hour, as well as the final 15-30 minutes of critical care on a given date.

Critical care services lasting less than 15 minutes over the first hour or less than 15 minutes beyond the final 30 minutes should not be reported separately.

Warning: Claim examiners see a red flag when two physicians divide the time and one bills using code 99291 while the other uses 99292 for the same patient on the same date.