ED Coding and Reimbursement Alert

Question: How should we code when an ED physician responds to a cardiac code on an in-house patient?

Ohio Subscriber

Answer: The code depends on the situation and the request made. If the call is for a code on an in-house patient, the request is usually for any physician and probably does not meet the requirements for a consultation.

If the problem is cardiac arrest and CPR is performed, the physician can code 92950 (cardiopulmonary resuscitation [e.g., in cardiac arrest]). Other procedures such as intubation (31500, intubation, endotracheal, emergency procedure) or central line placement (36489, placement of central venous catheter; percutaneous, over age 2) could also be coded if performed. If the patient is critical but CPR is not required, E/M codes (99281-99285) are appropriate if the time required on the floor is less than 30 minutes.

If the time is longer than 30 minutes, critical care code 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) may be appropriate. The criteria for coding critical care state that the patient must be critically ill or critically injured and that there is a high probability the patients life is threatened.

There are also important documentation considerations when coding for critical care. The physician must be precise in his/her documentation and understand what activities can be included in the time element. Time required for separately billable procedures (CPR, intubation, central lines, etc.) must be deducted from the critical care time.

Note: For more information regarding billing for critical care, please see the following articles in past issues of ED Coding Alert: January 2001, page 1; November 2000, page 85; and June 2000, page 45.