99292

Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes

CPT code 99292 is an add-on code used to report the evaluation and management (E/M) of a critically ill or critically injured patient for each additional 30 minutes of care provided beyond the initial 74 minutes reported under 99291. Critical care is defined as the direct delivery by a physician or other qualified health care professional of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. This type of care involves high complexity decision-making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient's condition. The time spent must be devoted exclusively to the patient and cannot be interrupted by the care of other patients. Time may be continuous or intermittent during the calendar date. Time spent includes the provider's presence at the bedside, time spent on the unit or at the nursing station reviewing test results or imaging, discussing the patient's care with other medical staff, and documenting the medical record. It also includes time spent with family members or surrogate decision-makers when the patient lacks capacity and the discussion is necessary for immediate medical decision-making. Certain procedures are bundled into the critical care time and cannot be reported separately, such as the interpretation of cardiac output measurements, chest X-rays, pulse oximetry, blood gases, and information data stored in computers (eg, ECGs, blood pressures, hematologic data); gastric intubation; temporary transcutaneous pacing; ventilatory management; and vascular access procedures (e.g., peripheral IVs).

Clinical Indications

  • Acute respiratory failure requiring intensive monitoring and intervention
  • Septic shock or other forms of severe hemodynamic instability
  • Acute myocardial infarction with life-threatening arrhythmias or cardiogenic shock
  • Severe trauma involving multiple organ systems
  • Status epilepticus requiring continuous medication titration and neurological monitoring
  • Severe acid-base or electrolyte disturbances (e.g., severe hyperkalemia, profound ketoacidosis)
  • Post-operative management of high-risk surgical patients with unstable vital signs
  • Acute renal failure requiring emergent initiation of continuous renal replacement therapy (CRRT)

Procedure Steps

  1. Identify that the patient meets the criteria for critical illness or injury with a high probability of imminent deterioration.
  2. Deliver intensive medical management involving high-complexity medical decision-making.
  3. Monitor vital organ system functions continuously or at frequent intervals.
  4. Review and interpret diagnostic data (e.g., labs, imaging, monitor tracings) specific to the critical condition.
  5. Coordinate care with the nursing staff and other specialty consultants involved in the patient's stabilization.
  6. Perform necessary bundled procedures such as ventilator management or interpretation of physiological data.
  7. Discuss the patient's clinical status and treatment goals with the patient or family members/surrogates if the patient is incapacitated.
  8. Document the total time spent in critical care, ensuring that time spent on separately billable procedures is excluded from the count.
  9. Verify that the first 74 minutes of care have been documented under code 99291 before applying 99292 for the additional increments.

Coding Guidelines

  • 99292 is an add-on code and must always be reported in conjunction with the primary code 99291.
  • To report 99292 for the first time, the total critical care time must reach at least 75 minutes (74 minutes for 99291 plus at least 1 minute for 99292).
  • Each unit of 99292 represents an additional 30 minutes of care. For example, 75–104 minutes = 99291 x 1 and 99292 x 1; 105–134 minutes = 99291 x 1 and 99292 x 2.
  • Time spent performing procedures that are not bundled into critical care (e.g., central venous catheter placement, CPR, endotracheal intubation) must be deducted from the total critical care time.
  • If two or more physicians in the same specialty and group provide critical care to the same patient on the same day, their time is combined and reported as if by a single physician.
  • If a physician provides critical care to a patient during a surgical global period, the care must be unrelated to the surgery to be billed, or must meet the criteria for a complication that requires the physician to provide services beyond the usual postoperative care.
  • Documentation must clearly state the total time spent in critical care to support the use of 99292.

Associated ICD-10 Codes