The CPT code 99291 (critical care, first hour) is used to report the services of a physician providing full attention to a critically ill or critically injured patient from 30-74 minutes on a given date. Only one unit of CPT code 99291 may be billed by a physician for a patient on a given date. Physicians of the same specialty within the same group practice bill and are paid as though they were a single physician and would not each report CPT 99291on the same date of service.
The following illustrates the correct reporting of critical care services:
Total Duration of Critical Care Codes
Less than 30 minutes 99232 or 99233 or other appropriate E/M code
30 – 74 minutes 99291 x 1
75 – 104 minutes 99291 x 1 and 99292 x 1
105 – 134 minutes 99291 x1 and 99292 x 2
135 – 164 minutes 99291 x 1 and 99292 x 3
165 – 194 minutes 99291 x 1 and 99292 x 4
194 minutes or longer 99291 – 99292 as appropriate (per the above illustrations)
Critical Care Services and Other Evaluation and Management Services Provided on Same Day
When critical care services are required upon the patient’s presentation to the hospital emergency department, only critical care codes 99291 – 99292 may be reported. An emergency department visit code may not also be reported.
When critical care services are provided on a date where an inpatient hospital or office/outpatient evaluation and management service was furnished earlier on the same date at which time the patient did not require critical care, both the critical care and the previous evaluation and management service may be paid. Hospital emergency department services are not payable for the same calendar date as critical care services when provided by the same physician to the same patient.
Physicians are advised to submit documentation to support a claim when critical care is additionally reported on the same calendar date as when other evaluation and management services are provided to a patient by the same physician or physicians of the same specialty in a group practice.