ED Coding and Reimbursement Alert

Question: A patient becomes unresponsive in the ED and the physician begins critical care. After 13 minutes of critical care, the family changes the code status to do not resuscitate (DNR). A morphine drip is started and the patient is allowed to slowly pass away without any interventions. For the next 20 minutes, the physician supports the patient with pain control and oxygen until she passes away. During this time, the physician is still documenting blood pressures, and injecting pain medication. Can this supportive time be considered critical care?Oregon SubscriberAnswer: Since the physician did not provide at least 30 minutes of critical care before the comfort care, you cannot report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes ...) for this encounter.Do this: On the claim, choose a 9928x ED E/M code for the service based on encounter notes; your scenario [...]