Primary Care Coding Alert

Question: A patient came into our office for a scheduled visit. We sent the patient directly to the hospital for an outpatient test. On the way home, the patient became extremely ill, stopped back by our office and collapsed in the waiting area. We performed CPR and gave oxygen. The emergency medical technicians arrived and transported the patient to the hospital. How should we code this scenario?

Dee Dee Thomas
Mercy Medical Associates-Sardinia, Sardinia, Ohio

Answer: If a documented evaluation and management (E/M) service was provided prior to sending the patient to the hospital for tests, the appropriate level may be coded for the first visit. These codes may include 99201-99205 or 99211-99215 (office or other outpatient visit, new or established patient), 99241-99245 (office consultation), or 99381-99387 or 99391-99397 (preventive medicine services, new or established patient), depending on the type of visit conducted.

Depending on the documentation available, you may be able to code critical care (99291 or 99292) and CPR (92950) for the second visit. Please note that the use of the critical care codes is not limited by place of service. In addition, 99058 (office services provided on an emergency basis) may be reported for payers other than Medicare.

Although some coders do not think it is necessary, others recommend that you add modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code for the first visit if billed. In addition, because of the unusual situation, coders recommend that you send the documentation and a cover letter outlining the circumstances when you file the claim.