tci E/M Coding Alert - 2015 Issue 10

Reader Question: Don't Assume ICU Means Critical Care

Question: My physician often rounds on patients in the intensive care unit (ICU). He feels that because the patient is in critical condition and in the ICU, he should be able to bill critical care codes for these encounters. I disagree. Can you please clarify when we can report critical care codes? Pennsylvania Subscriber Answer: You are correct. You cannot bill the critical care codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and 99292 (... each additional 30 minutes [List separately in addition to code for primary service]) simply...

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