Additional Critical Care time CPT 99292

I recently found guidance in the CODING FOR CHEST MEDICINE 2009 book by the American College of Chest Physicians that "critical care of less than 15 mintues beyond the first 74 minutes may not be reported separately". Per the CPT book critical care time of 75-104 mintues is billed as 99291 and 99292. Am I missing something in the CPT book or is the Chest Medicine book incorrect?

critical care codes

The way that I am understanding is anything less than 30 minutes is not coded as critical care. 30-74 minutes starts the critical care and is 99291 and so on per the chart.

critical care

If after coding the documented time, you have 14 minutes over, it is not coded as an additional 99292

so...

when does 99292 kick in? Does 16 minutes qualify? Or does it need to be 29 minutes?

(as an aside, I see critical care very overused. A patient in the ED with chest pain and a normal EKG, no acute MI, will get coded with critical care code. Or an asthmatic who requires nebs but is not near intubation or respiratory failure. I can see the RAC really going after those!)

critical Care

Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single, or multiple, vital organ system failure; and/or to prevent further life threatening deterioration of the patient’s condition. Examples of vital organ system failure include (but are not limited to):
• Central nervous system failure;
• Circulatory failure;
• Shock;
• Renal, hepatic, metabolic, and/or respiratory failure.

You should use CPT code 99291 (evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) to report the first 30-74 minutes of critical care on a given calendar date of service. You can only use this code once per calendar date to bill for care provided for a particular patient by the same physician or physician group of the same specialty. When you exceed 74 minutes of critical care you add 99292 for each additional 30 minutes.

Initial critical care (99291) requires at least 30 minutes before CC time kicks in.

here's an example

documented cc time is 85 min, I would bill this as 99291 and 99292 per the chart in the CPT book. But according to the Chest Medicine book there is not 15 min beyond the first 74 so 99291 is billable but 99292 is not. If the Chest Medicine book is correct why wouldn't the chart in the CPT book have 89-104 min instead of 75-104 min?