ED Coding and Reimbursement Alert

Question: Is anyone billing procedure codes for an emergency physician who rides with a patient from one ED to another, either via ambulance or helicopter? This is a new area that we are starting to see more often and we have no idea if there are such codes...any help would be greatly appreciated!

Oklahoma Subscriber

Answer: If the physician is providing critical care services during patient transport, you would report that service for the time spent. The code choice will depend on the age of the patient involved.

If the critical patient is pediatric, meaning 24 months of age or less, you'd report the physician's work in the ambulance/helicopter with 99466 (Critical care services delivered by a physician, face-to-face, during an inter-facility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport) and 99467 (...each additional 30 minutes. If the patient is older than age two, 99291 and 99292 should be reported instead.

As to the question of procedures, for both 99291-99292 and 99466-99467, if the physician performs procedures that are not bundled into these critical care codes, those procedures are separately reportable.

The following services are bundled when reporting 99466: routine monitoring evaluations (e.g., heart rate, respiratory rate, blood pressure, and pulse oximetry), the interpretation of cardiac output measurements (93562) chest X-rays (71010, 71015, 71020), pulse oximetry (94760, 94731, 94762), blood gases and information data stored in computers (e.g., ECGs, blood pressures, hematologic data) (99090), gastric intubation (43752, 43753), temporary transcutaneous pacing (92953) ventilatory management (94002, 94003, 94660, 94662) and vascular access procedures (36000, 36400, 36405, 36406, 36415, 36591, 36600).

Just be sure that the physician subtracts the time spent performing the procedures from the time claimed for critical care.