Medical Billing Critical Care Myths Take I

Medical Billing Critical Care Myths Take I

Critical care medical billing codes have been accused of reimbursing meager amounts of money. In fact, critical care codes can bring you a lot of money. The medical billing codes 99291-99292 can only bring proper reimbursement if you steer clear of the common pitfalls.

Perhaps the most common medical billing myths in critical care is that each visit must meet every element of an evaluation and management exam. Many times this is difficult during critical visits. In reality, medical billing codes for critical care are timed based. For example, the medical billing CPT code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) is for the first 30 minutes of service. Each additional 30 minutes of care would be billed using a 99292.

If you read these medical billing codes closely, it is easy to see that specific evaluation and management elements are not present in the descriptions. Every other evaluation and management code specifically details which elements are required. This is not the case for critical care medical billing codes.

Another largely misunderstood element of critical care is the place of service. You will still get medical billing reimbursement if critical care is perform somewhere other than the critical care unit or the intensive care unit. Critical care can happen anywhere. It can happen in observation, during surgery , in radiology , etc. anywhere a physician applies lifesaving procedures for over 30 minutes of time can be considered critical care. One thing to keep in mind, is to report the correct place of service. If the patient is treated in radiology for cardiac arrest and then admitted, you would report a inpatient service.

There are many misconceptions about critical care coding. These two myths are some of the most common pitfalls you can fall into. Keep these medical billing rules straight and much of your accuracy will improve.

View all Articles by: Melissa Clark, CCS-P