The physician documented providing 45 minutes of critical care time for a patient with diabetic ketoacidosis, a life-threatening condition. According to CPT® guidelines, critical care services are time-based. Code 99291 is used to report the first 30-74 minutes of critical care provided on a given date. Since the documented time of 45 minutes falls within this range, 99291 is the only appropriate code. When critical care criteria are met and services are provided, this code is reported in lieu of other E/M services, such as an emergency department visit code.

B. 99291, 99292: Code 99292 is an add-on code for each additional 30 minutes beyond the initial 74 minutes. It is not applicable here as the total time was only 45 minutes.

C. 99222: This is an initial hospital inpatient care code. The service documented was rendered in the Emergency Department, not as an initial inpatient encounter by the admitting physician.

D. 99285: This is an Emergency Department visit code. Per CPT® guidelines, when the service qualifies as critical care, codes 99291-99292 are reported instead of the ED visit codes.

1. American Medical Association. (2023). CPT® 2024 Professional Edition. In the Evaluation and Management section

under "Critical Care Services

" the guidelines state

"Code 99291 is used to report the first 30-74 minutes of critical care on a given date." The guidelines for code 99292 specify its use for "each additional 30 minutes." This confirms that only 99291 is appropriate for 45 minutes of service.

2. AAPC. (2023). 2024 CPC Official Study Guide. Chapter 2: Evaluation and Management. The guide clarifies that critical care codes (99291

99292) are used for critically ill or injured patients and are based on the total time spent by the provider. It emphasizes that these codes are not used in conjunction with other E/M codes for the same time period by the same provider. This supports reporting 99291 instead of 99285.