ED Coding and Reimbursement Alert

Question: A 34-year-old patient with a tree nut allergy came to the ED after accidentally eating a pecan. Her face showed signs of increasing swelling and she complained of trouble breathing as if her throat was closing. The emergency physician ordered an epinephrine injection, as well as several other medications, and since the patient had developed increasing respiratory distress, the doctor intubated her to maintain her airway. The patient responded well to the epinephrine and the swelling began to subside after 40 minutes, after which she was admitted to the hospital. The physician documented 32 minutes of critical care time outside of separately billable procedures and provided a diagnosis of anaphylaxis due to the tree nuts. Do we code for the intubation separately, or is it included in the critical care?

Codify Subscriber

Answer: The intubation is not included in the code for critical care, and it can be separately reported. Therefore, on the claim, you would report the following codes:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes)
• 31500 (Intubation, endotracheal, emergency) for the tube placement
• T78.05XA (Anaphylactic reaction due to tree nuts and seeds, initial encounter)

Apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99291 to show that the intubation is separate from the critical care services.