Documentation of Critical Care Services
Critical Care services (99291-99292) are time-based, and improper documentation of time is a frequent reason that payers deny payment for these services. Educating providers to document time appropriately will help to maximize reimbursement and reduce additional documentation requests (ADRs).
The American Medical Association (AMA) defines critical care as the direct delivery by a physician(s) or other qualified healthcare professional of medical care for a critically ill or critically injured patient. A critically illness or injury is further defined as an impairment of one or more vital organ systems, with imminent or threatening deterioration in the patient?s condition.
Code 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes reports the first 30-74 minutes of critical care; while 99292 ?each additional 30 minutes (List separately in addition to code for primary service) reports additional blocks of time in 30-minute increments beyond the first 74 minutes. These codes are reported once per calendar day.
To appropriately claim 99291 and 99292, the critical care note must specify the total duration of critical care time spent with the patient. The time must be explicit, and should include the verbiage ?minutes.? The total time should include all time spent engaged in work directly related to the patient?s care, whether that time was at the immediate bedside, or elsewhere on the floor. The time spent does not have to be continuous, but the time cannot be the same for each critically ill/injured patient, nor can it be a span (Eg: ?I spent two to three hours with the patient?).
CPT(R) guidelines explain that time spent on activities that do not directly contribute to the treatment of the patient, or time spent performing separate reportable procedures or services, should not be included in the time reported as critical care time. CPT(R) guidelines require that the reporting provider must devote his or her full attention to the patient during the time specified as critical care, and therefore cannot provide services to any other patient during the same time.
