This post is supposed to be a primer about billing in critical care. I’ll update it regularly as practices change.
Critical care (CC) billing is based on time rather than complexity. There are two current procedural terminology (CPT) codes we should be familiar with:
99291: evaluation and management of the critical patient, primary service (30-74 minutes)
99292: evaluation and management of the critical patient, each additional 30 minutes
The first physician in a group providing 30-74 minutes of CC after midnight should bill 99291 with subsequent time at the bedside by either this physician or other physicians in the group adding 99292 for each chunk of 30 CC minutes.
Interestingly, you don’t have to be credentialed in CC to bill for it. Second of all, time related to procedures does not count towards 99291/99292 as procedures are billed separately (CPR, central line placement, IO placement, thoracostomy, endotracheal intubation, etc). If a resident/fellow is involved in the patient’s care, a GC modifier is included with the billing. If a procedure is performed, the original CC claim (99291/99292) should be addended with modifier 25.
Only one 99291 per patient per day can be claimed by a physician providing medical care at the bedside in a patient who either has a life threatening condition or a potential for life threatening condition (ie, pretty much everyone in the ICU).
So what actually counts towards CC billing time? Reading through the chart, talking to consultants at the bedside, rounding, time spent talking to the family or surrogate decision makers, family meetings, etc. We must exclude time where we are not immediately available to the patient (ie, making phone calls from home).