A 64-year-old woman with a history of heart failure with reduced ejection fraction (HFrEF) was admitted to the hospital with pneumonia one day ago and is being started on intravenous (IV) antibiotics. You see her on day two in the morning after she’s received 30 ml/kg of IV fluids overnight for sepsis and has normal BP and heart rate (HR). You bill 99233 by MDM criteria. When you see her later in the afternoon, her BP is 80/45, HR is 110, and you’re thinking of giving more IV fluids, but you also think she might need pressors in the intensive care unit (ICU). You evaluate her, start ordering tests, and medications, and ask the intensivist to evaluate her as well. You spend 40 mins in the afternoon for this encounter.
What level of billing does this qualify for?
This would qualify for the critical care (99291) level of billing. This would be appropriate since you’re providing care for a critically ill, injured patient in which there is acute impairment of one or more vital organ systems, such that there’s a probability of imminent or life-threatening deterioration of the patient’s condition. It involves highly complex decision making to treat single or multiple vital organ system failures and to prevent further life-threatening deterioration of the patient’s condition.
Tip
You can bill 99291 by providing between 30 and 74 minutes of care for a patient with imminent or life-threatening deterioration of their health condition regardless of where their physical location is. You can bill 99292 for every additional 30 minutes involved in their care.
Dr. Mehta is the medical director and an assistant professor of medicine at the University of Cincinnati Medical Center in Cincinnati.
Hi. Would the 99291 replace the previous charge for 99233 for that day or would Medicare reimburse both charges?
Can you clarify critical care billing for a critical access hospital?
Specifically can you bill for critical care time in a critical access hospital as I’ve been having a debate with my billing team.
If your only encounter with the patient was when they were critically ill, then you can only bill 99291 (you need at least 30 mins of direct care for the patient) and you can add 99292 if you exceed 74 mins of time directly caring for the patient. You can bill 99233 if they were not critically ill and then 99291 if they became critically ill later in the day during a separate encounter with them and they needed longer than 30 mins of direct care. In this case, both billing codes could be accepted.
I don’t think the type of hospital or bed matters for billing. It matters that you are providing care for a patient with a potentially life threatening condition and that is at risk of significant deterioration in their condition or death if you do not intervene. Any provider can bill for this.
For physician (professional) billing, critical care can occur in any location/site of service and qualify for billing.