Code: 99291
Description: Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
Context: This code is used for the first 30-74 minutes of providing critical care services to a patient who is critically ill or injured. Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single or multiple vital organ system failure.
Guidelines for Proper Use:
- Specific Use for Initial Critical Care: Apply 99291 for the first 30-74 minutes of critical care provided to patients who are critically ill or injured. This includes direct delivery of medical care and decision-making of high complexity.
- Documentation of Time and Complexity: Ensure healthcare providers’ documentation accurately reflects the time spent providing critical care, the nature of the illness or injury, and the complexity of the care provided.
- Exclusion of Non-Critical Care Services: Do not use 99291 for care that does not meet the definition of critical care or for services provided beyond the initial 74 minutes (additional time is billed using a different code).
- Compliance with Critical Care Protocols: Use 99291 in accordance with standard critical care guidelines and protocols, as well as payer-specific rules.
- Billing for Continuous Time: Critical care time should be continuous and exclusive to one patient, and the time billed should reflect this focus.
Common Misuses of 99291:
- Using for Less Complex Care: Misuse occurs if 99291 is applied to care that is not of high complexity or does not require critical care skills.
- Inaccurate Time Reporting: Billing for less than 30 minutes or for fragmented time that does not add up to the minimum required continuous time.
Omission of Detailed Documentation: Failing to provide detailed documentation of the services provided, the complexity of the patient’s condition, and the time spent in direct care can lead to misuse of this code.
