How To Use CPT Code 99292

CPT 99292 refers to critical care services for each additional 30 minutes beyond the initial 30-74 minutes of direct critical care treatment. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99292.

1. What is CPT 99292?

CPT 99292 is a medical billing code used to describe critical care services provided by a healthcare professional for each additional 30 minutes beyond the initial 30-74 minutes of direct critical care treatment. This code is an “add-on” code, meaning it must be used in conjunction with a primary CPT code. The purpose of this code is to ensure proper billing and reimbursement for healthcare providers who spend additional time providing critical care services to critically ill or injured patients.

2. 99292 CPT code description

The official description of CPT code 99292 is: “Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)”.

3. Procedure

1. Identify the patient as critically ill or injured, requiring critical care services.
2. Document the total time spent providing critical care services, including the initial 30-74 minutes and any additional 30-minute increments.
3. Ensure that the primary CPT code for the initial critical care service has been billed.
4. Bill CPT 99292 for each additional 30-minute increment of critical care services provided beyond the initial 30-74 minutes.
5. Include proper documentation to support the medical necessity of the additional critical care services.

4. Qualifying circumstances

Patients eligible to receive CPT code 99292 services must meet the following criteria:

• They are critically ill or injured, with vital organ failure or at risk of further life-threatening deterioration.
• The healthcare provider has performed critical care services, including high-complexity decision-making to assess, manipulate, and support vital system functions.
• The total time spent providing critical care services on a given date of service is at least 30 minutes, which can be continuous or intermittent.

5. When to use CPT code 99292

It is appropriate to bill the 99292 CPT code when a healthcare provider has spent additional time beyond the initial 30-74 minutes providing critical care services to a critically ill or injured patient. The additional time must be documented and medically necessary to treat the patient’s condition. The code should be used in conjunction with the primary CPT code for the initial critical care service.

6. Documentation requirements

To support a claim for CPT 99292, the following information must be documented:

• The patient’s critical illness or injury, including vital organ failure or risk of further life-threatening deterioration.
• The critical care services provided, including high-complexity decision-making and support of vital system functions.
• The total time spent providing critical care services on the date of service, including the initial 30-74 minutes and any additional 30-minute increments.
• Medical necessity for the additional critical care services provided.

7. Billing guidelines

When billing for CPT code 99292, healthcare providers should follow these guidelines:

• Ensure that the primary CPT code for the initial critical care service has been billed.
• Bill CPT 99292 for each additional 30-minute increment of critical care services provided beyond the initial 30-74 minutes.
• Include proper documentation to support the medical necessity of the additional critical care services.
• Be aware of any payer-specific rules or requirements related to billing for critical care services.

8. Historical information

CPT 99292 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Similar codes to CPT 99292

Five similar codes to CPT 99292 include:

• CPT 99291: This code is used for the initial 30-74 minutes of critical care services provided to a critically ill or injured patient.
• CPT 99281-99285: These codes are used for emergency department evaluation and management services, depending on the complexity of the patient’s condition and the services provided.
• CPT 99288: This code is used for physician direction of emergency medical systems (EMS) personnel in the management of a critically ill or injured patient.
• CPT 99468-99476: These codes are used for neonatal and pediatric critical care services, depending on the patient’s age and the services provided.
• CPT 99477-99480: These codes are used for initial and continuing intensive care services provided to a critically ill or injured newborn or infant.

10. Examples

1. A patient in the ICU with septic shock requires continuous monitoring and treatment adjustments. The physician spends an initial 60 minutes providing critical care services and an additional 45 minutes later in the day. The physician would bill CPT 99291 for the initial 60 minutes and CPT 99292 for the additional 45 minutes.
2. A patient in the emergency department with a severe asthma attack requires 90 minutes of critical care services, including intubation and mechanical ventilation. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 30 minutes.
3. A patient with multiple organ failure requires 120 minutes of critical care services, including management of multiple intravenous medications and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 60 minutes (two units).
4. A patient with a traumatic brain injury requires 105 minutes of critical care services, including intracranial pressure monitoring and management. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 45 minutes.
5. A patient with acute respiratory distress syndrome requires 75 minutes of critical care services, including management of mechanical ventilation and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 15 minutes.
6. A patient with a severe gastrointestinal bleed requires 150 minutes of critical care services, including blood transfusions and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 90 minutes (three units).
7. A patient with a severe drug overdose requires 135 minutes of critical care services, including management of multiple intravenous medications and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 75 minutes (two units).
8. A patient with a life-threatening infection requires 180 minutes of critical care services, including management of multiple intravenous medications and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 120 minutes (four units).
9. A patient with a severe burn injury requires 165 minutes of critical care services, including wound care and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 105 minutes (three units).
10. A patient with a life-threatening allergic reaction requires 115 minutes of critical care services, including management of multiple intravenous medications and continuous monitoring. The physician would bill CPT 99291 for the initial 30-74 minutes and CPT 99292 for the additional 45 minutes.