Pulmonology Coding Alert

Procedures Does Critical Care Include?

Question: A pulmonologist spent 80 minutes providing critical care to an adult respiratory distress syndrome (ARDS) patient in the intensive care unit. The physician performed an examination, ordered and reviewed tests, made treatment decisions, and provided care. As part of the treatment, the pulmonologist spent 10 minutes of this time intubating the patient to begin ventilation management. What services should I report?


Pennsylvania Subscriber


Answer: The only procedure that you should report in addition to the critical care is the intubation (31500, Intubation, endotracheal, emergency procedure).

CPT includes ventilator management (94656-94657) and continuous positive airway pressure (94660, Continuous positive airway pressure [CPAP] ventilation, initiation and management) in critical care services (99291-99292). But CPT does not bundle the endotracheal tube placement (31500) into critical care or ventilator management, and you may separately bill the procedure.

Report the critical care services with 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). Because the total time for critical care (70 minutes) does not meet or exceed 75 minutes, do not also bill +99292 (... each additional 30 minutes [list separately in addition to code for primary service]).

You may only report 70 minutes of critical care time because 10 of the 80 minutes was spent on intubation, a separately billable procedure.

To indicate that the critical care is significant and separately identifiable from the intubation, append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99291.