Advanced Search

ED Coding and Reimbursement Alert

Reader Question:

(Nearly) Dead Men Tell No Tales: Apply History Exemption Caveat for Critical Care

Published on Thu Oct 20, 2011

Question: If a patient comes to the ED in critical condition and is not able to give a history, can we apply a caveat? Does that caveat also apply to physical exam or does the doctor need to perform and document a physical exam? West Virginia Subscriber Answer: If the patient qualifies for critical care, code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) does not have the typical E/M code requirements of history, physical exam, and medical decision making. As such, the typical history and physical exam required elements (HPI, ROS etc.) are not in place; rather, the documentation must support that the patient was critically ill and the time requirements for 99291 were met. If however the time thresholds for critical care are not met but the urgency of the patient's clinical condition and/or mental status make obtaining the [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All