ED Coding and Reimbursement Alert

Question: A 22-year-old motor-vehicle accident victim reports with multiple injuries and the ED physician provides 84 minutes of care to this critically injured patient. During this time the physician uses ultrasound imaging to place a femoral line (non-tunneled centrally inserted venous catheter). Is the line placement separately reportable, or is it part of the critical care package?

Idaho Subscriber

Answer: You should carve the line placement service out of the total critical care time, as it is a separately reportable service. The introductory notes for Critical Care Services in CPT^® 2013 list several procedures that are included in 99291 — e.g., chest x-rays (71010, 71015or 71020) and cardiac output studies (93561, 93562) among others. Placement of a femoral line is not on this list.

Coding: Let’s say it took the ED physician 13 of those 84 encounter minutes to place the line. On the claim, you would report the following:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the 71 minutes of critical care (84 total minutes minus 13).
• 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) for the femoral line placement 
• +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real time ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure])  along with 36556 for the ultrasound guidance.