Reporting Time Spent in Critical Care Service

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Reporting Time Spent in Critical Care Service

• Since critical care is a time-based code, the
  physicians 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.

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Reporting Time Spent in Critical Care Service
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)
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Reporting Time Spent in Critical Care Service

• 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
  providers 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 physicians progress note must link the
  family discussion to a specific treatment issue
  and explain why the discussion was necessary on
  that day.

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Reporting Time Spent in Critical Care Service

• 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 providers 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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