ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient with severe chest pain arrived at the ED by ambulance transport. He was admitted to critical care where he received a chest x-ray from the attending physician. The critical-care physician also read and interpreted a routine ECG. Are both of these services bundled under critical care (99291 and 99292) or can they be billed separately? Arkansas Subscriber   Answer: Depending on what kind of chest x-ray the patient received and whether the physician analyzed the ECG, you may be eligible to submit multiple codes. It's easy to miss the opportunity in this case because the CPT mandates that for reporting critical care, a range of services must be included if the physician(s) performs them during the critical period. The long list of bundled services includes interpretation of cardiac output measurements (93561, 93562), chest x-rays (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases and information data stored in computers (e.g., ECGs, blood pressures, hematologic data [99090]), gastric intubation (43752, 91105), temporary transcu-taneous pacing (92953), ventilator management (94656, 94657, 94660, 94662) and vascular access procedures (36000, 36410, 36415, 36540, 36600).

At first glance it does not look promising, but the CPT manual cracks open another door: "Any services performed which are not listed above should be reported separately." In other words, any CPT code not specifically listed can be coded. This means that you cannot code the following services because they are included in the definition of critical care: 71010 (Radiologic examination, chest; single view, frontal), 71015 (Radiologic examination, chest; stereo, frontal) or 71020 (Radiologic examination, chest, two views, frontal and lateral). However, if the patient received a complete chest view, for example, you can code it separately: 71030 (Radiologic examination, chest, complete, minimum of four views).

Note: Other radiological codes that would be exempt from the critical care inclusion rule encompass 71021 (Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure), 71022 (Radio-logic examination, chest, two views, frontal and lateral; with oblique projections), 71023 (Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy), 71034 (Radiologic examination, chest, complete, minimum of four views; with fluoroscopy) and 71035 (Radiologic examination, chest, special views [e.g, lateral decubitus, Bucky studies]).

Even though all of the above are chest x-rays, their codes are not included in critical care and you may ethically submit for reimbursement. The trick as always is to avoid categorical exclusions unless required to do so. The same principle applies to the other patient care service referenced in your question. You cannot use code 99090 (Analysis of clinical data stored in computers [e.g., [...]