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Bill facility critical care independent of physician billing

APCs Weekly Monitor, June 23, 2006

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Bill facility critical care independent of physician billing

QUESTION: Are CPT 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) billed for the facility considered independent of what the provider documents and bills?

For example, in the ED setting, can the facility bill 99291 and 99292 only when the physician/provider documents and bills for critical care time as well? Does the "S" status indicator of these codes suggest that we bill this as a procedure to match the provider procedure note?

ANSWER: Bill 99291 for the facility independent from the provider. If the facility has criteria for billing critical care in its E/M system and meets those criteria, it may bill critical care.

Usually the patient's status is severe or unstable and this is typically supported by the physician documentation. Also, because critical care is not considered time-based for the facility, only bill 99291 (not 99292). Code 99291 has a status indicator S, which indicates critical care on the facility side and does not include procedures. Professional critical care codes have NCCI edits, but these differ for facility reporting.

Therefore, facilities may code and bill all appropriate procedures in addition to critical care service code 99291.

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