Understanding Critical Care Services: CPT Code 99292 & Medicare Reimbursement

Medical Coding

Procedure performed: Critical care services

Patient: Jack Smithton

Diagnosis: Acute respiratory distress syndrome

Date of service: [Insert date of service]

CPT code: 99292

Description of CPT code 99292: Critical care services, per hour; first hour

Reimbursement amount: Varies depending on the payer. For Medicare, the allowed amount for CPT code 99292 is $172.00.

Modifier used: -51 (Multiple procedures)

Explanation of modifier -51: Modifier -51 is used to indicate that multiple procedures were performed on the same day by the same physician. In this case, Dr. Martin provided 1 hour and 20 minutes of critical care services, which is equivalent to 2 hours of service. Therefore, modifier -51 is used to indicate that two units of CPT code 99292 were billed.

Total reimbursement amount: $344.00 (2 units of CPT code 99292 at $172.00 per unit)