EM Coding Alert

Question: A 68-year-old woman with cirrhosis presents to the emergency department (ED) complaining of vomiting blood. She appears very pale, is hypotensive and tachycardic. The ED physician begins her resuscitation by starting two large-bore IVs, administering IV fluid boluses, and having her typed and cross-matched for blood. The physician documents providing 70 minutes of critical care in order to stabilize this hypotensive patient (6:44 a.m. to 7:54 a.m.). Once she has stabilized and we were in the process of admitting her to the hospital, the nurse reports that the patient is now diaphoretic and complaining of chest pain. Notes indicate that the physician provided an additional 37 minutes of critical care to stabilize the patient, from 10:59 a.m. to 11:36 a.m. How much critical care time can I code for in this instance?

Colorado Subscriber

Answer: You should be able to code for 107 minutes of critical care, even though the physician provided the care in two separate time frames. Just make sure that both portions of the encounter meet the definition of critical care. On the claim, report 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, and +99292 (…each additional 30 minutes [List separately in addition to code for primary service]) for the remaining 33 minutes of critical care.

Explanation: Critical care time does not need to be continuous; the physician could provide critical care at different points of the same day to the patient. Just make sure that any time you code as critical care qualifies as critical care: in other words, the physician spends all critical care time stabilizing a patient with a critical illness or injury.