| Printer Friendly Version |
| Section: | Visits |
| Number: | V-20 |
| Topic: | Prolonged Detention or Critical Care |
| Effective Date: | December 5, 2005 |
| Issued Date: | December 5, 2005 |
| Date Last Reviewed: | 12/2005 |
Indications and Limitations of Coverage
The terminology for critical care codes 99291 and 99292 specifies that the codes and number of services billed for these services rendered by a physician must be reported using the actual amount of time spent with the patient. See the Table Attachment below for examples of the proper way to bill for critical care services. Critical care of less than 30 minutes total duration on a given date should be reported with the appropriate E&M code. Code 99291 is used to report the first 30-74 minutes of critical care on any given date. It should be used only once per date, even if the time spent by the physician is not continuous on that date. Note: Payment may be made for 99291 when billed by different physicians in the same group practice, Code 99292 is used to report each additional 30 minutes beyond the first 74 minutes. It also may be used to report the final 15-30 minutes of critical care on a given date. Critical Care services of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes are not reported separately. See Medical Policy Bulletin V-11 for information on ventilatory assistance. See Medical Policy Bulletin V-13 for information on maternal/neonatal retrieval and the transportation of critically ill patients. Description Prolonged detention or critical care is a specific service which requires the continuous presence of the doctor in the immediate vicinity of the patient while providing a service which only he or she can provide. |
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| 99291 | 99292 |
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Prolonged Detention or Critical Care is also eligible in the outpatient hospital (20) and emergency room (2E) places of service. The criteria listed above are applicable to outpatient hospital and emergency room Prolonged Detention or Critical Care. |
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| [Version 001 of V-20] |
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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.
Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.
Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
