Internal Medicine Coding Alert

Published on Sun Aug 31, 2003 PDF

Question: My internist attended to a critical care adult patient in transport to another facility. How can I bill for the treatment he provided on the way to the facility? What should I include in the report?

Utah Subscriber

Answer: You should report critical care codes 99291-99292 because your patient is older than 24 months. But if  that patient had been an infant, you could have reported either 99289 (Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport) or +99290 (... each additional 30 minutes [list separately in addition to code for primary service]), depending on the patient's age and the time your internist treated the patient.
 
Remember that your carrier may require supporting documentation that your physician performed critical care services. CPT states that the patient must have a critical illness or injury that acutely impairs one or more vital organ systems, such as vital organ failure, circulatory failure, shock, and respiratory failure. For example, your
internist treats a 15-year-old who has an acute respiratory failure (518.81) from an asthma attack. In this case, submit 99291 for your physician's 30 minutes of work. But you shouldn't report a critical care code if your physician saw the patient for less than 30 minutes. When your internist treats a patient for less than 30 minutes, you should list 99215 (Office or other outpatient visit ... of an established patient ...).