ED Coding and Reimbursement Alert

Question: A patient presented to the ED as critical care, and the physician subsequently admitted him to inpatient status. Later, the patient coded on the floor. The ED physician who saw him in the ED responded to the code blue on the floor. Medicare is denying our claim for the code-blue service, saying we are allowed to bill for only one E/M service per day. Is this because the same physician saw the patient? How should we report this?


Georgia Subscriber
 

Answer: You can only report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) once per calendar day, so you should add any more time the physician spent treating the patient (beyond that first hour) to the critical care time already documented.
 
After you-ve totaled up all the critical care time and subtracted the first hour, you-ll know how many units of +99292 (... each additional 30 minutes) to report. When adding the time together, you-ll need to consider the critical care the physician provided both in the emergency department and on the floor.

Tip: Talk to your carrier about what place of service it wants you to report for the care. The correct coding would be POS 23 (Emergency room--hospital) for the 99291 claim (along with any units of 99292 applicable in the ED), and POS 21 (Inpatient hospital) for any additional units of 99292 (provided outside the ED). Ask your carrier to ensure it will accept the places of service in this format.

If the physician performed CPR, remember to report code 92950 (Cardiopulmonary resuscitation) and to subtract these minutes out for the critical care provided on the floor.