ED Coding and Reimbursement Alert

Question: If one ED physician admits a patient to observation care and another ED physician provides critical care to that patient while he or she is in observation, can the doctor providing the critical care bill for this service?

New Hampshire Subscriber

 
Answer: Essentially, the answer is yes. The ED physician who provides critical-care services can bill for them, but it is important to ensure that critical care is being provided. CPT 2001 revised its terminology to help clarify the critical-care issue and make it easier to determine what is considered critical care.
 
Critical-care codes 99291 and 99292 are time-based codes and, as such, the amount of time the physician spends in critical care must be documented in the patient's medical record (the physician's time must be devoted solely to that patient). You should carefully review cases in which a patient is in observation status/care and critical care is provided under the supervision of an ED physician. Before coding and billing, you have to ask whether this patient is really an observation-status patient or an ICU patient. Because observation status is so heavily misused in hospitals, you should be cautious in these cases. For more information, refer to the critical-care section of the CPT Manual or read the article on critical care in the June 2001 ED Coding Alert.

 
-- Answers to You Be the Coder and Reader Questions provided by Michael Granovsky, MD, CFO of Greater Washington Emergency Physicians, a five-physician group staffing a 24,000-visit ER in Maryland; and John Turner, MD, PhD, medical director of documentation and coding, healthcare financial services at Team Health, an ED staffing firm in Knoxville, Tenn.