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Question about Critical care service question on Exam similator

michtitus

Guest
Messages
5
Best answers
0
I Purchased this software called Coding Certificate Exam Similator and was practicing the E/M section for the CPC exam this Saturday and I came across this one question and I think the software is wrong? I don't know, but why would the answer be based on a 24 month or older person instead of a 21 month old or pediatric? I am so confused.

QUESTION: A 21-month-old patient is stung by a bee and goes into
anaphylactic shock due to an allergic reaction. He is
rushed to the emergency room, where he receives critical
care by an emergency physician for two-and-a-half hours.
What is the correct way to code this encounter?

a. 99293 my answer
b. 99295
c. 99291,99292 x 3
d. 99291
 

ARCPC9491

True Blue
Messages
700
Location
Stafford, VA
Best answers
0
I Purchased this software called Coding Certificate Exam Similator and was practicing the E/M section for the CPC exam this Saturday and I came across this one question and I think the software is wrong? I don't know, but why would the answer be based on a 24 month or older person instead of a 21 month old or pediatric? I am so confused.

QUESTION: A 21-month-old patient is stung by a bee and goes into
anaphylactic shock due to an allergic reaction. He is
rushed to the emergency room, where he receives critical
care by an emergency physician for two-and-a-half hours.
What is the correct way to code this encounter?

a. 99293 my answer
b. 99295
c. 99291,99292 x 3
d. 99291
Hello,

No error was made here, they are trying to trick you by saying 21 month old...

99293 is for "Initial inpatient pediatric critical care...." According to your scenario, the patient was taken to the ER and treated by the ER doctor, nothing is stated about being admitted. ER is considered outpatient.

99291 and 99292 are not place of service specific and may be used for inpatient and/or outpatient, and regardless of age when they are outpatient.

If you read what 99293 - 99296 "excludes" in the CPT book ... it specifically states EXCLUDES "critical care services provided to child up to age 24 months in an outpatient area (e.g., emergency department) (99291, 99292)"

Hope that helps!
 
Last edited:

renifejn

Guru
Messages
208
Best answers
0
No, it's not an error. 99293 is a for initial inpatient critical care, per day. In the CPT book under inpatient neonatal and pedicatric critical care services it states for "critical care services provided in the outpatient setting( eg, emergency dept or office) for neonates and pediatric patients up through 24 mos of age, see the hourly critical care codes 99291, 99292."
 
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