# Code blue modifiers



## cathyjo (Mar 4, 2010)

We have a patient who came to the ED where we charged a critical care visit. A few hours later, same date, person coded while still in the ER waiting for a bed.  The only thing done by our ER doc was an intubation.  What modifier would we append to the intubation?

A few hours later - which was after midnight so a new date- the person coded again while still in the ER.  Treated by another ER doc.  This same ER doc was called an hour later to another code still in ER and the patient died.

Very confusing case - can you help?  None of the modifiers really seem to fit. 

Thanks!!
Cathy


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## FTessaBartels (Mar 4, 2010)

*99291-99292*

It helps to think of these kinds of situations as all one visit until either 1) patient is admitted or 2) calendar date changes. 

First ED doc bills critical care (99291 - 99292 depending on time documented)
You need a *-25 modifier on the E/M *code. No modifier needed on intubation (CPT 31500, I assume).

IMPORTANT QUESTION:  Has patient been admitted? (Even though physically still in the ER awating a bed?)  If so, once admitted your POS is inpatient!

After midnight - new date of service.  Critical care (if appropriate) - you can add all the critical care time together to code.  *NOTE * If you are going to bill for the CPR you *must subtract the time spent in CPR *from the critical care time. Technically if your ER doctor is the one who pronounces the patient he could also bill a discharge (but if you're billing critical care I would just ignore the discharge code).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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