Documentation Pearls for Critical Care Services’ Time Requirement By Jason Adler, MD, FACEP, and Hamilton Lempert, MD, FACEP, CEDC

Critical Care: It’s All About the Timing

Question: I’m a bit confused about the time requirement for critical care services. There are times when I’m at the patient’s bedside for less than 30 minutes, but have been told the time requirements can include more than bedside time. Can you elaborate?

Answer: That’s a great question. You’re correct in that critical care is a time-based code, 99291 for 30–74 minutes and 99292 for each additional 30 minutes. That includes time at the bedside, record review, documentation time, and historical and treatment conversations with EMS, consultants, and the patient’s family (eg, as proxy for the patient).

For the time to count, you should be focused on the care of only that patient and be immediately available to the patient. There are times, however, that the clock is paused; this includes time caring for other patients as well as procedures that are separately billed, such as placing a central line, CPR, intubation, and chest tubes. Teaching physicians should include only the time they personally spent caring for the patient and not time spent by a resident. It’s also best to specify the total amount of time you spent providing critical care (ie, “50 minutes”) rather than using a range such as “30–74 minutes.”

For more information, please check the ACEP reimbursement FAQs at https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Critical-Care-FAQ/.

Brought to you by the ACEP Coding and Nomenclature Committee.

Dr. Adler is assistant medical director of the emergency department at MedStar Montgomery Medical Center and chief coding and reimbursement officer for Emergency Medicine Associates in Olney, Maryland. Dr. Lempert is chief medical officer, health care financial services, at TeamHealth, based in Knoxville, Tennessee.