Pulmonology Coding Alert

Dont Bundle Every Code Into Critical Care

Published on Sun Jun 01, 2003

Stick to your guns: If your physician performs a separately billable procedure while rendering critical care, make sure you get paid for it.

Although the 2003 CPT guidelines clearly state all the bundled procedures included in critical care, other private insurance companies sometimes try to bundle other services, says Nettie McFarland, RHIT, CCS-P, with Healthcare Billing Systems Inc.

If you receive denials for services not listed in the bundled services, appeal the claims and send your insurance companies regulatory information, McFarland says. The time and hassle are "worth the effort" because you usually receive correct reimbursement after the appeal, she says.

These services are bundled under critical care:

Indicator dilution studies for cardiac: 93561, 93562

Chest x-rays, one and two views: 71010, 71015, 71020

Pulse oximetry: 94760, 94761, 94762

Blood gases

Information data stored in computers (including EKGs, blood pressures, hematologic data): 99090. Note, this bundle does not include 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) or 93042 (Rhythm ECG, one to three leads; interpretation and report only).

Gastric incubation: 43752, 91105

Temporary transcutaneous pacing: 92953

Ventilatory management: 94656, 94657, 94660, 94662

Vascular access procedures: 36000, 36410, 36415, 36540, 36600.

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