Reimbursement For Critical Care Medical Billing Codes

Get Full Reimbursements For Critical Care Medical Billing Codes

When performing medical billing for critical care services, much accuracy must be followed. It may not be the most important thing on a physician’s mind when a critical patient comes into the emergency room, but medical billing elements cannot be overlooked.

There are two elements that are imperative for critical care medical billing: time and medical necessity. In order to use the codes 99291 or 99292 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes and each additional 30 minutes), the patient must have a critical illness or injury. Critical is defined as having one or more acutely impaired vital organs that are life threatening. In order to bill a patient as critical, medical necessity must be shown. This means that medical records and accurate documentation of illness or injury my be provided.

Time is the other important medical billing element of critical care. Time needs to be documented in order to bill a critical care visit. To be paid, the 99291 must show that a physician solely treated a patient for thirty minutes performing life-saving services to stabilize a patient’s illness or injury. It is not acceptable in medical billing to include other procedures that are separately billable in this time calculation. If a patient is critically ill, this should not be necessary at all.

Many times physicians forget to keep track of the amount of time spent with an emergency room patient. These physicians and technicians should be educated on the necessity for time accuracy. Let them know the difference in reimbursement, or have them shadow a medical billing staff member for an hour. Educate the physicians on what would make medical billing easier. Hospital staff members, medical billing personnel, and physicians are all on the same team.

View all Articles by: Melissa Clark, CCS-P