ACEP Emergency Department Facility Coding – Critical Care (CPT 99291 & 99292)

Overview

Critical Care services are billed when the patient has a life-threatening condition requiring direct, constant physician attention. These cases often demand complex decision-making, advanced interventions, and frequent reassessment to prevent further deterioration.

• CPT 99291 – First 30–74 minutes of critical care

• CPT 99292 – Each additional 30 minutes beyond the initial 74 minutes

• Type A: APC 617

• Trauma Team Activation: G0390 (when criteria are met in designated trauma centers)

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Possible Interventions

Could include interventions from previous levels, plus any or all of:

• Multiple parenteral medications requiring constant monitoring

• Major trauma care/multiple surgical consultants

• Chest tube insertion

• Major burn care

• Treatment of active chest pain in acute coronary syndrome (ACS)

• Administration of IV vasoactive medications (per guidelines)

• CPR

• Defibrillation/Cardioversion

• Pericardiocentesis

• Administration of ACLS drugs during cardiac arrest

• Therapeutic hypothermia

• Bi-PAP/CPAP initiation and management

• Endotracheal intubation

• Cricothyrotomy

• Ventilator management

• Arterial line placement

• Control of major hemorrhage

• Pacemaker insertion through a central line

• Delivery of a baby

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Potential Symptoms/Examples Which Support the Interventions

• Multiple trauma

• Head injury with loss of consciousness

• Burns threatening life or limb

• Coma (except hypoglycemic)

• All types of shock: septic, cardiogenic, spinal, hypovolemic, anaphylactic

• Drug overdose impairing vital functions

• Life-threatening hypo/hyperthermia

• Thyroid storm or Addisonian crisis

• Cerebral hemorrhage (any type)

• New-onset paralysis

• Non-hemorrhagic stroke with vital function impairment

• Status epilepticus

• Acute myocardial infarction

• Cardiac arrhythmia requiring emergency treatment

• Aortic dissection

• Cardiac tamponade

• Leaking or ruptured thoracic/abdominal aneurysm

• Tension pneumothorax

• Acute respiratory failure, pulmonary edema, status asthmaticus

• Pulmonary embolus

• Fat or amniotic fluid embolism

• Acute renal failure

• Acute hepatic failure

• Diabetic ketoacidosis

• Lactic acidosis

• DIC or other severe bleeding disorders (hemophilia, ITP, TTP, leukemia, aplastic anemia)

• Major envenomation by poisonous reptiles

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Key Notes for Coders

• 99291 covers the first 30–74 minutes of critical care.

• 99292 is used for each additional 30 minutes beyond the first 74 minutes.

• Medicare considers 99292 bundled into 99291 but still requires documentation for reporting.

• Trauma centers can additionally bill G0390 when trauma team activation criteria are met.

• Documentation must clearly outline the total critical care time, patient’s condition, interventions, and reassessments.