ED Coding and Reimbursement Alert

Question: A patient with a stated diagnosis of obstructive sleep apnea is rushed to the ED via ambulance; she is unconscious and her breathing is uneven. During the E/M service, the ED physician determines that the patient is suffering acute respiratory failure. He then performs 20 minutes of continuous positive airway pressure (CPAP) to stabilize the patient. Total encounter time is 46 minutes. Notes indicate that the patient was suffering from a critical illness, and the physician provided uninterrupted service during the encounter. Is this a 99291 scenario? Louisiana Subscriber Answer: The ED physician exceeded the 30-minute minimum required for critical care, so you can report 99291 in this instance. On the claim, report the following: " 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care " 518.81 (Acute respiratory failure) appended to 99291 to represent the patients [...]