ED Coding and Reimbursement Alert

You Be the Coder:

Code Critical Care and Additional Services When Warranted

Published on Thu Jun 19, 2014

Question: The ED physician spends a total of 115 minutes caring exclusively for a critically injured patient who has suffered a stroke of the carotid artery and an acute anterolateral wall acute myocardial infarction (AMI).

The physician orders rapid sequence intubation to facilitate breathing, and uses a sequence of drugs during the intubation: 5 mg of intravenous Versed and 150 mg of IV succinylcholine. The intubation took 16 minutes, and the physician spent the other 99 minutes of the encounter time at the patient’s bedside or conversing with his wife to get medical information the patient cannot provide. Can I code the intubation and critical care separately?

New Hampshire Subscriber

Answer: You can code for the critical care and intubation; the drug supply codes are a no-go, though. 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 first 74 minutes of critical care
+99292 (… each additional 30 minutes [List separately in addition to code for primary procedure]) for the remaining 25 minutes of critical care

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99291 and possibly +99292 depending on the payer to show that the critical care and intubation were separate services

31500 (Intubation, endotracheal, emergency procedure) for the intubation
433.11 (Occlusion and stenosis of carotid artery with cerebral infarction) appended to 99291, +99292, and 31500 to represent the patient’s stroke.
410.11 (Acute myocardial infarction; of anterior wall; initial episode of care) appended to 99291, +99292, and 31500 to represent the patient’s heart attack.

ED Coding and Reimbursement Alert

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Code Critical Care and Additional Services When Warranted
Question: The ED physician spends a total of 115 minutes caring exclusively for a critically injured [...]

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