ED Coding and Reimbursement Alert

Critical care codes have changed frequently in the past 10 years, so make sure you're up-to-date with the coding guidelines. Time Determines the Critical Care Code "Time spent" is the cornerstone to critical care coding. How much time your physician spends with the patient determines when you report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and additional critical care time, +99292 (... each additional 30 minutes [list separately in addition to code for primary service]).

To report the first critical care code, your physician must have spent at least 30 minutes of time with the patient. When you have a patient who requires less than 30 minutes of critical care, report an E/M code, but include your record of time spent in critical care, says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa. You should use 99291 only once per date, even if the physician's time spent is not continuous.

These time frames indicate how to apply 99291 and 99292:

less than 30 minutes: appropriate E/M codes
30-74 minutes: 99291
75-104 minutes: 99291 and 99292
105-134 minutes: 99291 and 99292 x 2
135-164 minutes: 99291 and 99292 x 3
165-194 minutes: 99291 and 99292 x 4
for each additional 30 minutes: add another 99292. Services 'Bundled' Under Critical Care Stick to your guns: If your physician performed a separately billable procedure while rendering critical care, make sure you get paid for it. Although the 2002 CPT guidelines clearly list all the bundled procedures under critical care, insurance companies sometimes try to bundle other services, warns Nettie McFarland, RHIT, CCS-P, with Healthcare Billing Systems Inc. in Daytona, Fla. Reporting separate procedures with critical codes is "the most significant problem we face" with critical care reimbursement, she says. If you get denied for services not listed in the bundled services, appeal the claims and send your insurance companies regulatory information, McFarland says. The time and hassle are "worth the effort" because you usually receive correct reimbursement after the appeal, she states. These services are bundled under critical care:

Indicator dilution studies for cardiac: 93561, 93562
Chest x-rays, one and two views: 71010, 71015, 71020
Pulse oximetry: 94760, 94761, 94762
Blood gases and information data stored in computers (including ECGs, blood pressures, hematologic data): 99090. Note: This bundle does not include 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) or 93042 (Rhythm ECG, one to three leads; interpretation and report). Gastric incubation: 43752, 91105
Temporary transcutaneous pacing: 92953
Ventilatory management: 94656, 94657, 94660, 94662
Vascular access procedures: 36000, 36410, 36415, [...]