Forum - Questions & Answers

Aug 20th, 2014 - Mand0984 11 

Critical Care 99291/99292

When we bill 110 minutes of critical care time we bill 99291 and 99292 x2. Medicare always denies the 2nd 99292 as a duplicate. Is there anything we can do to avoid this denial?

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Aug 20th, 2014 - LBAROGIANIS 250 

re: Critical Care 99291/99292

99291 =30-74 MINS, 99292 EACH ADD 30,

I would not bill an additional 99292 for using less than 30 mins. I am not sure why they would deny as duplicate, but you can always call them.

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Aug 20th, 2014 - Mand0984 11 

re: Critical Care 99291/99292

These are the guidelines per CMS:
Total Duration of Critical Care Codes
Less than 30 minutes 99232 or 99233 or other appropriate E/M code
30 - 74 minutes 99291 x 1
75 - 104 minutes 99291 x 1 and 99292 x 1
105 - 134 minutes 99291 x1 and 99292 x 2
135 - 164 minutes 99291 x 1 and 99292 x 3
165 - 194 minutes 99291 x 1 and 99292 x 4
194 minutes or longer 99291 – 99292 as appropriate (per the
above illustrations)

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Aug 20th, 2014 - LBAROGIANIS 250 

re: Critical Care 99291/99292

I am wondering if the reason they are denying for duplicate is because another physician used the same codes and possibly the same speciality. We have these denials now and then, but usually from Humana...

Geez.. yours is a tough one.. Just call them.. that is the only way your going to really know.

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