Since critical care is a time-based code, the physician’s progress note must contain documentation of the total time involved in providing critical care service. Critical care codes 99291 (evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) and 99292 (critical care, each additional 30 minutes) are used to report the total duration of time spent by a provider providing critical care services to a critically ill or critically injured patient, even if the time spent by the provider on that date is not continuous.
CPT 99291 and 99292
- CPT code 99291 (evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) to report the first 30-74 minutes of critical care on a given calendar date of service. You can only use this code once per calendar date to bill for care provided for a particular patient by the same physician or physician group of the same specialty.
- CPT code 99292 (critical care, each additional 30 minutes) is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care.
- Critical care of fewer 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.
|Total Duration of Critical Care||Appropriate CPT Codes|
|Less than 30 minutes||99232 or 99233 or other appropriate E/M code|
|30- 74 minutes||99291 x 1|
|75- 104 minutes||99291 x 1 and 99292 x 1|
|105- 134 minutes||99291 x 1 and 99292 x 2|
|135- 164 minutes||99291 x 1 and 99292 x 3|
|165- 194 minutes||99291 x 1 and 99292 x 4|
|195 minutes or longer||99291- 99292 as appropriate (per the above illustrations)|
Time Involved with Decision Makers
The time involved with family members or other surrogate decision-makers, whether to obtain a history or to discuss treatment options may be counted toward critical care time only when:
- The patient is unable or incompetent to participate in giving history and/or making treatment decisions,
- The discussion is absolutely necessary for treatment decisions under consideration that day, and
- All of the following are documented in the provider’s progress note for that day:
- The patient was unable or incompetent to participate in giving history and/or making treatment decisions, as appropriate,
- The necessity of the discussion (e.g., no other source was available to obtain a history” or “because the patient was deteriorating so rapidly needed to discuss treatment options with family immediately”),
- The treatment decisions for which the discussion was needed, and
- The substance of the discussion is related to the treatment decision.
- The physician’s progress note must link the family discussion to a specific treatment issue and explain why the discussion was necessary on that day.
Things to Remember in Critical Care Service
- All other family discussions, no matter how lengthy, may not be counted towards critical care time.
- For any given period of time spent providing critical care services, the provider must devote his or her full attention to the patient and, therefore, cannot provide services to any other patient during the same period of time.
- The time involved in performing procedures that are not bundled into critical care (i.e., billed separately) may not be included and counted toward critical care time.
- The provider’s progress note must document that time involved in the performance of separately billable procedures was not counted toward critical care time.
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