ED Coding and Reimbursement Alert

Question: Can you count the time a physician is involved in "pre hospital care" in critical care time? All I can really find is that the patient needs to be "directly available to the physician." We have some controversy on this with the physicians that I am hoping to solve. Any help would be appreciated.

Georgia Subscriber

Answer: The critical care codes do have some pre-service time allocated in assigning their relative value units. It is not uncommon to have some notification that a major trauma patient or patients are on their way, giving the emergency physician a little time to prepare for their arrival. In fact, the facility trauma response team activation code, G0390 (Trauma response team associated with hospital critical care service) specifically requires hospital notification by two-way radio.

There is a CPT® code 99288 (Physician direction of emergency medical systems [EMS] emergency care, advanced life support) that describes two-way communications with EMS personnel during transport to the ED, but it has no RVUs assigned and is not paid by Medicare. There are no CCI edits dealing with reporting codes 99291 and 99288 together.

Although code 99288 can include physician direction of procedures on a critically ill patient, those services are not performed or provided under their direct supervision. The CPT® Assistant published an article in the November 2007 issue dealing with code 99288, acknowledging that it "represents true physician work and significant medical liability."