Anesthesia Coding Alert

Question: The anesthesiologist inserted an emergency airway and is billing for two hours of critical care services during the patients transport. Is the critical care time billable by the anesthesiologist, especially considering that the other physician also billed for the critical care? If so, which codes are most appropriate?

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Answer: Although maintaining an airway may not qualify for critical care, emergency intubation is billable (31500, Intubation, endotracheal, emergency procedure). If the services constitute critical care, report them with 99291 (Critical care, E/M of the critically ill or critically injured patient; first 30-74 minutes) and +99292 ( each additional 30 minutes [list separately in addition to code for primary service]). If the anesthesiologist is attending the patient at a different time from the other physician and documentation shows that, critical care could be billable but it could be difficult to justify two physicians reporting the same patients transport for the same reasons. You could bill for the transport with 99082 (Unusual travel [e.g., transportation and escort of patient]), but most carriers probably will not pay a physician for this because they are paying a transport company (i.e., ambulance) for its service, which includes patient care. Medically reasonable and necessary services that do not meet all the criteria necessary to report critical care should be reported with the appropriate E/M codes subsequent hospital care codes (99231-99233) or inpatient consultation codes (99251-99255), based on the level of service provided.
  Reader Questions and You Be the Coder reviewed by Vicki Embich, anesthesia coding secretary for West Florida Medical Center Clinic, Pensacola.