CAPC Palliative Care Discussion Forum
Billing and Finance
I had a thought today as I was called in to meet with a family in the ICU. I spent 65 minutes with the family of a deteriorating critically ill patient and the ICU attending. Based on my reading of CPT code 99291, my discussion regarding decision-making with the family, on the ICU floor, met criteria for critical care time (see link at bottom).
This is important to Palliative Care billing as the "face-to-face" requirement to bill prolonged service codes (99356/7) does not apply for critical care time. The wRVU difference between 65 minutes of followup inpatient face to face time (allowing a 99233 and 99356) and critical care time (99291) is small (only about 0.5 wRVU) but the difference between 35 minutes of followup (99233) and 35 minutes of critical care time (99291) is HUGE (2 vs 4.5 wRVU). Even more impressive is the difference between 1.5 hours of non face-to-face family meeting time (still only a 99233) and 1.5 hours of critical care time (99291+99292) is incredible (2.0 vs 6.75 wRVU).
Julie, I'd love to know your thoughts on the above. My tightly formed question is this: does a decision-making family meeting held in an ICU for a patient who is critically ill and cannot make his own decisions qualify as critical care time?
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Critical Care Billing in HPM
Several criteria must be met and documented to code 99291 and 99292. The patient must have organ failure, the family meeting must be required for medical decision making and it should be documented that the patient is unable to participate due to lack of capacity for medical decision making.
Time spent in providing emotional support may not be coded as critical care time; only time spent in medical decision making. The provider must also be immediately available to the patient (i.e. in the ICU).
Dana Lustbader MD