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Critical Care Services

Luz Posted Wed 20th of June, 2012 18:19:25 PM

Can someone help me with the following question. How many minutes after you meet the 74 minutes for 99291 you need to bill 99292 x1.Is it appropriate to bill 99291x1 and 99292 x1 for 75 minutes of critical care or 105 min for 99291 x1 and 99292x2? According to the CPT book CPT 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes. But the description of CPT-99292 states each additional 30 min. This is confusing, up to 30 min I interpret as less than 30 minutes-but how much less. Your input is appreciated.

SuperCoder Answered Thu 21st of June, 2012 07:34:26 AM

See the example at the CPT book just above the code 99291. There is a table depicting the time & code examples. The moment you cross 74 min. mark, for any additional minute & up to next 30 min you can bill 99292. So if it's 75 min. total time, then you should bill 99291x1 and 99292 x1. The same you should do till the total time is 104 min. Any minute in b/w 75 and 104 is to be coded with 99291x1 and 99292 x1.

Luz Posted Thu 21st of June, 2012 13:37:30 PM

Thank you for your input; that is how I interpret the guidelines. However, I need to know if Medicare requires 15 minutes of service after the 74min to bill 99291x1 &99292x1 and so on. I was informed that Novitas,Medicare of NJ had a teleconference this week regarding critical services and they said that in order to bill 99292 you need to meet a minimum of 15 min beyond the 74 min. I read the Medicare manual Pub 100-04-c12- 30.6.12 and it does not mention the additional 15 min. Are we suppose to figure this out or is it written in another publication? Your help in clarifying this issue is appreciated. Also if you know of any publication that may have this information,please direct me to it-thank you.

Luz Posted Fri 22nd of June, 2012 12:07:40 PM

Please respond to my reply question-thank you.

SuperCoder Answered Fri 22nd of June, 2012 19:21:47 PM

We are working on this. Please be patient. Thanks

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