ED Coding and Reimbursement Alert

You want clinical critical care examples? You got 'em. The ins and outs of critical care coding are difficult to discern without some concrete examples to illustrate 99291 scenarios. So what does a really detailed clinical scenario for critical care look like? We asked Greer Contreras, CPC, senior director of coding for Marina Medical Billing Service Inc. in California. She gave us two samples. The challenge: Look at these case studies and see if you can get all the codes -- diagnosis (ICD-9) and procedure/service (CPT) -- right: Scenario 1: Physician Treats CHF A patient presents to the ED with worsening shortness of breath (SOB); the physician examines the patient and discovers elevated blood pressure and tachycardia. The physician orders a Cardizem drip to control the patient's heart rate; she then orders labs, a chest x-ray, and an electrocardiogram (EKG). The physician performs multiple re-evaluations, interprets both the x-ray and EKG, and [...]