ED Coding and Reimbursement Alert

Experts: Make sure physician knows what to count toward 99291. Your ED physician provides 42 minutes of critical care to a patient, but you report a level-five ED E/M instead. No big deal, right? Wrong: The critical care code pays around $45 more per claim. Use this FAQ to grab all the green you can on potential critical care claims. What's Critical Care? For coding purposes, a patient must be critically ill or injured in order to report critical care services. "Critically ill or injured patients have one or more vital organ systems acutely impaired, such that there is a high probability of imminent or lifethreatening deterioration in the patient's condition" if the physician does not intervene, explains Deb Williams, CPC, coding supervisor at Horizon Billing Specialists in Grand Rapids, Mich. In short: Critical care occurs when a lack of physician intervention will quickly lead to a worsening of the [...]