The Application of "Critical Care" Codes in the ER Setting

ACUTE CARE's ER Coding Manager, Eileen Clausen, CPC, has prepared an overview and analysis of The Application of "Critical Care" Codes in the ER Setting, which we've posted to our website.

An excerpt:

Current Procedural Terminology 2005 gives us a clear understanding of the application of critical care codes 99291 and 99292. I will synopsize this information for you.

Critical Care is the evaluation and management of the critically ill or critically injured patient; the first 30-74 minutes is coded with 99291. (Any care given under 30 minutes is coded as a regular Evaluation and Management) Each additional 30 minutes above 74 are coded 99292 and is listed separately from the primary service of 99291.

To further clarify, Critical Care is the direct delivery by a physician of medical care for a critically ill or critically injured patient, either as an outpatient or inpatient, or in the emergency department. This care must involve high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient’s condition. Examples would be but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic and/or respiratory failure. This care typically requires interpretation of multiple physiologic parameters and/or application of advanced technology. Critical care is used to report the total duration of time spent by a physician providing services to this type of patient. The time does not have to be continuous, but must be documented in the chart, “the physician must devote their full attention to the patient and, therefore, cannot provide services to any other patient during this same period of time”. Your time should include work directly related to this individual’s care, at the bedside, elsewhere on the unit, with the nursing staff, reviewing test results, consulting other physicians, recording or documenting information, and discussions with the family provided that the conversation bears directly on the management of this incident. Time spent outside the unit or off the floor is not included in critical care time allowance.