ED Coding and Reimbursement Alert

If patient's critical care and visit satisfies time regs, 99291 is the better bet. When scouring the notes for evidence of an ED caveat scenario, coders can easily forget to ask themselves one simple question: Can I report a critical care code for this scenario? The answer's yes more often than you might think, says Caral Edelberg, CPC, CPMA, CCS-P, CHC, president of Edelberg Compliance Associates in Baton Rouge, La. "Many patients who qualify for the caveat may also be candidates for critical care. If the condition is severe enough that the patient's ability to provide this information is impaired, then the condition may be critical," she explains. Critical Care Omits Specific History Component Considering critical care and the caveat simultaneously can make your head spin, as the ED caveat does not even apply to 99291 (Critical care, evaluation and management of the critical ill or critically injured patient; first [...]