ED Coding and Reimbursement Alert

Question: A patient reports to the ED with critical injuries to her abdomen and chest; she was in an auto accident, and the ED physician cares exclusively for this patient for 98 minutes. During the encounter, the physician spends eight minutes inserting a peritoneal trocar and needle into the umbilicus, sending saline into the peritoneal cavity to check for intra-abdominal bleeding and infection; he then drains and collects the fluid. The physician also spends another five minutes ordering and interpreting a two-view frontal and lateral chest x-ray. Should I code the needle procedure and xrays separately, or are these part of the critical care package? Arkansas Subscriber Answer: Code the peritoneal lavage your physician performs separately and be sure to subtract out the eight minutes spent performing the procedure. The x-rays,however, are included in the critical care package. On the claim, report the following: - 99291 (Critical care, evaluation and [...]