ED Coding and Reimbursement Alert

Question: Can I report a critical care code when the diagnosis is a mental illness, such as severe depression?

Florida Subscriber

Answer: Many Medicare carriers have local medical review policies for 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) that outline the acceptable diagnoses for the code. Unfortunately, severe depression is not on many of these lists.

For non-Medicare patients, you would need some justification that the severe depression put the patient at risk for "a high probability of imminent or life-threatening deterioration in the patient's condition," according to many insurers. Good examples of such a condition - and patients for whom you could report critical care codes - include septic and hypertensive encephalopathy. Straightforward depression, on the other hand, might be harder to qualify for 99291.

-- Reader Questions and You Be the Coder answered by Mike Granovsky, MD, CPC, FACEP, chief financial officer of Greater Washington Emergency Physicians in suburban Maryland.