Anaphylaxis:A Lesson on Proper Critical Care Coding

Coding for services performed on anaphylactic patients is a complicated issue, so coders need to learn when they can bill for critical care services and which anaphylaxis procedures are included in the critical care and other E/M service codes.
According to Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C., critical care codes (99291-99292) can be used for the treatment of anaphy-lactic shock. However, many allergists find it difficult to decide whether to categorize the services provided to anaphylactic-shock patients as critical care or an upper-level office visit. The fact that critical care coding guidelines are stringent for the documentation needed to support critical care as a medical necessity only complicates the issue further. Therefore, you need to understand when it is appropriate to code for critical care services performed on patients who have had an anaphy-lactic reaction. Take a look at three different scenarios that will help clarify this complex issue for you.
Allergic Reaction Needs Immediate Critical Care Services
A 30-year-old woman is exposed to peanuts during lunch. She presents in the allergist's office with mild symptoms of anaphylactic shock including itching and restricted breathing. In the office, she loses consciousness. Because the patient is unconscious and the physician has to perform CPR, bill the service with critical care codes. Critical care is appropriate because the woman's condition is life-threatening. As long as the time spent performing critical care services is more than 30 minutes, you can use the critical care codes (99291-99292). 99291 corresponds to the first 30-74 minutes, and 99292 refers to each additional 30 minutes. Any critical care less than 30 minutes should be reported with the appropriate E/M code.
In dealing with anaphylaxis, the allergist will often need to perform a myriad of procedures, most of which you need to bill separately. Remember that you can bill separately for procedures not included in the critical care bundle and cannot include them in the time element of the critical care. The critical care time spent with the woman is 30 minutes. CPR is also performed. The billing consists of two codes:

99291-25 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes


92950 Cardiopulmonary resuscitation.

Be aware of relevant services that you can bill separately from the critical care:

CPR (92950)


31500 Intubation, endotracheal, emergency procedure


Tracheostomy (31603, 31605)


90780 IV infusion for therapy/diagnosis, administered [...]

- Published on 2002-12-01