cpt 99291, cpt code 99291, 99291 cpt code

CPT 99291 | Initial E/M Of Critically Ill Or Injured (30-74 Minutes)

CPT 99291 describes the initial, comprehensive evaluation and management of critically ill or critically injured patients, provided by the physician for the first 30-74 minutes on a given service date, meeting specific criteria of patient’s condition, physician’s decision-making, and time spent providing the service.

What Is CPT Code 99291?

CPT code 99291 can be used to report the evaluation and management of critically ill or critically injured patients.

CPT 99291 may be used when a physician provides critical care services for the first 30-74 minutes on a given service date.

The critical care service provided must meet specific criteria, including the patient’s condition (critically ill or critically injured), the physician’s decision-making (high complexity), and the time spent providing the service (at least 30-74 minutes).

CPT 99291 is used to bill for the initial, comprehensive evaluation and management of the critically ill or critically injured patient, which includes taking a history, performing a physical examination, and developing a treatment plan.

It also includes ordering and interpreting diagnostic studies, administering medications and treatments, monitoring the patient’s condition, and consulting with other healthcare providers as needed.

It is used when patients are critically ill or critically injured, and the physician provides direct face-to-face critical care and decision-making; this time-based service is billable as a critical care service.

Description

The CPT book defines CPT code 99291 as: “Critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes.”

Procedure

The physician may provide critical care services to patients in a critical care unit, such as a CCU, ICU, respiratory care unit, or emergency room. However, the medical documentation must demonstrate the necessity of these services.

How To Use CPT 99291

The following criteria must be met to use CPT code 99291 correctly: 

  1. The patient must be critically ill or injured, such as vital organ failure or a life-threatening health condition.
  2.  The physician must perform high-complexity decision-making to assess, manipulate, and support vital system functions to treat single or multiple vital organ system failures or to prevent further deterioration of the patient’s condition.
  3.  The physician must spend at least 30 minutes providing critical care services on a given service date. This time can be continuous or intermittent and must be documented in the medical record. The time spent evaluating, managing, and providing critical care services to the critically ill or injured patient will be calculated to determine the total time to be billed.
  4.  The physician must provide critical care services at the immediate bedside of the patient or elsewhere on the floor as long as the physician is immediately available to the patient. The physician must not provide services to any other patient during the same period.

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4 Comments

  1. Martin Buser says:

    Hi
    I am inquiring about the impact of the change in CPT code 99291. When Medicare increased the time required from 60 to 74 minutes, did Medicare also change the requirement that a NP could add their hours to the physicians time to help meet the threshold before adding 99292?
    Thanks
    Martin

    1. Hi Martin,

      CMS permits concurrent follow-up care for upcoming critical care intervals for providers in the same specialty. If a physician in the same group provides a patient with 74 minutes of acute care services on a given date (74 minutes + 30 minutes = 104 total minutes), that practitioner can only report CPT code 99292. Billing add-on code 99292 requires at least 30 minutes of documented time. By adding 30 minutes to the 74 minutes, the 104 minutes that can report for 99292 would obtain. (Not after 75 minutes.)

      It excludes if the subsequent treatment does not meet the critical care criteria. After the initial session, for example, there is treatment. In minutes, multiply the initial acute care provided by an internist by 99291. CPT 99291 would still be reported by a single provider in the same specialty, according to DOS. Internist B times 99292 minutes equals critical care in the evening.

  2. Thank you for your response.
    One more question.
    Does the 104 minute requirement only apply to AGGREGATE Billing? Otherwise, no change from 2021 rules?
    Thanks
    Martin

    1. The practitioner can be provided critical care services to the same patient on the same date for a total of 104 minutes (74 minutes plus 30 minutes = 104 total minutes), exceeding the required cumulative time. Reiterating, the minimum billing time for add-on code 99292 is thirty minutes. If aggregate billing can be used to reach CPT code 99291, an additional 30 minutes beyond the 74 minutes must be reached for the accumulated billing procedure.

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