Critical care has high relative value units and payments so it’s important to know the coding rules. This article describes what can be included in the time of critical care what can’t be included, and the time thresholds for reporting critical care.
The care of a critically ill patient billed based on time documented in the medical record.
Here’s how the Medicare Carriers Manual describes critical care in Chapter 12, Section 30.6.12 A:
Critical care includes the care of critically ill and unstable patients who require constant physician attention, whether the patient is in the course of a medical emergency or not. It involves decision making of high complexity to assess, manipulate, and support circulatory, respiratory, central nervous, metabolic, or other vital system function to prevent or treat single or multiple vital organ system failure. It often also requires extensive interpretation of multiple databases and the application of advanced technology to manage the critically ill patient.
Billing and Coding Rules
In order to bill for critical care the patient’s condition must be critical, critical care must be provided and time must be documented in the medical record.
- Patient location in the critical care unit is not the determining factor: the condition of the patient is the determining factor
- Physician must be in attendance on the unit and immediately available to provide care
- Add the time for multiple visits on a calendar date and bill the total time
- Bill for covering partners of the same specialty as if they were one physician
- Bill 99291 only once in a calendar date, use 99292 for each additional 30 minutes
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