Cardiology Coding Alert

Question: A patient presented to the ED as critical care, and the cardiologist subsequently admitted him to inpatient status. Later, the patient coded on the floor. The cardiologist who saw him in the ED responded to the code blue on the floor. Medicare is denying our claim for the code-blue service, saying we are allowed to bill for only one E/M service per day. Is this because the same physician saw the patient? How should we report this?

Georgia Subscriber

Answer: You can only report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) once per calendar day, so you should add any more time the physician spent treating the patient (beyond that first hour) to the critical care time already documented.

- After you've totaled up all the critical care time and subtracted the first hour, you'll know how many units of +99292 (... each additional 30 minutes) to report. When adding the time together, you'll need to consider the critical care the physician provided both in the emergency department and on the floor.

Keep in mind: Code 99292 is an add-on code you are meant to report in conjunction with 99291. If your payer denies this code as a second E/M service, your payer is not following CPT's structure. When you bill the critical care time for the day, you must add up the total critical care time and report it based on this value. The first 30-74 minutes, you should report 99291, the next 15-45 minutes with code 99292, and each subsequent 15-45 minutes with 99292. Remember: You can report 99291 only one time per day.

Tip: Talk to your carrier about what place of service it wants you to report for the care. The correct coding would be POS 23 (Emergency room -- hospital) for the 99291 claim (along with any units of 99292 applicable in the ED), and POS 21 (Inpatient hospital) for any additional units of 99292 (provided outside the ED). Ask your carrier to ensure it will accept the places of service in this format.

If the physician performed CPR, remember to report 92950 (Cardiopulmonary resuscitation) and to subtract the time spent providing this separately reportable service from the time you count when billing for critical care time.