Billing for a Critically Ill Patient
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.