ED Coding and Reimbursement Alert

Question: A patient suffering from acute respiratory failure presented to the ED. The physician performed 54 minutes of critical care. The notes indicate that the physician also provided endotracheal intubation and pulse oximetry during the encounter. Can I report the intubation and oximetry separately from the critical care?

California Subscriber Answer: When reporting critical care, certain services are bundled into the service. In your scenario, the intubation is separately reportable, but the pulse oximetry is not billable because it is bundled into both of the critical care codes.

On your claim, you should:

- report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes) for the critical care.

- report 31500 (Intubation, endotracheal, emergency procedure) for the intubation.

- attach ICD-9 code 518.81 (Acute respiratory failure) to 99291 and 31500 to represent the patient's respiratory failure. The CPR conundrum: Since CPR is a separately billable service, make sure you do not include time spent performing/overseeing CPR toward your critical care minutes. For example, if the total encounter time is 54 minutes and CPR is ongoing for 20 minutes, then you would only have 34 minutes of critical care.

When reporting critical care, remember that these services are bundled into codes 99291 and +99292 ( - each additional 30 minutes; List separately in addition to code for primary service):

- Cardiac output

- Chest x-rays

- Pulse oximetry

- Computer data

- Trancutaneous pacing

- Ventilator management

- Vascular access

- Gastric intubation On the other hand, these services are not bundled into 99291 or +99292.

- CPR

- Endotracheal intubation

- Pericardiocentesis
   
- EKG interpretations

- Central venous catheter placement