News: Critical care codes fall hard from COVID boom, resetting trend curve

Medicare utilization of CPT critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and the add-on code 99292 ( … ; each additional 30 minutes) jumped higher during the pandemic years, according to JustCoding.

However, that bump has subsided, and a review of 10 years of progress in critical care utilization suggests the codes have swiftly adjusted to pre-COVID levels.

Looking at the much-more-used 99291 code, there was a slight upward curve from 2014 to 2019 with an increase of 8.6%, from 5.7 million to 6.2 million claims. But in 2020, when the public health emergency was declared and many services took a hit, utilization zoomed to 6.5 million, a nearly 6% gain in one year.

The decline from there has been swift, with utilization decreasing to 5.9 million claims in 2023 (the most recent year of available Medicare claims data), marking a three-year fall of 9.7%. This leaves utilization only about 200,000 over 2014’s totals and a little under the six million reached in 2017. The regression of 99292 is even more marked: from 561,977 in 2014 to 647,333 in 2020, a rise of 15%, and a drop to 449,751 in 2023, nearly 31% down from the peak.

Changes in denial rates are traditionally modest for these codes. This remains true especially for 99291, stuck at 5% for five years running.

The specialists with the most critical care code claims in 2023 were emergency medicine, with 1.7 million, or 29%, of all 99291 claims and 84,271, or 19%, of all 99292 claims. Not far behind were pulmonologists (18% and 16%) and critical care intensivists (12% and 17%).

Editor’s note: This article was originally published in JustCoding.