Code Spotlight — Critical Care ServicesRT Welter & Associates is excited to present our monthly Code Spotlight! Each month, RT Welter & Associates will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. 

99291: Critical Care Services (99291-99292 – Critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes) are some of the most heavily scrutinized codes in all of CPT! They are a huge target for all payers and have put many Critical Care/Pulmonology practices out of business or on the dreaded Pre-Pay system due to lack of compliance. Here are some of the essentials for compliantly billing for critical care services:

  • Documentation must support the patient meets the definition of a “critically ill or injured” patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition. Be consistent regarding the critical risk of the patient throughout the entire note.
  • Documentation must also support time spent rendering critical care (a minimum of 30 minutes of critical care must be provided).