ED Coding and Reimbursement Alert

Question: A patient presented to the ED waiting room with multiple stab wounds. From documentation, it appears appropriate assessments were performed, IVs initiated, units of blood given, etc. Documentation regarding wound care described locations of about 12 stab wounds, but only one of these wounds had additional description: stab wound LUQ abd w/ peritoneal tissue protruding ... wounds dressed with Vaseline gauze. The patient was transferred to trauma center about 30 minutes after his arrival. Is there a CPT code for this level of wound care?

Sandy Colson
St. Joseph Healthcare, Albuquerque, N.M.

Answer: If the duration of patient care was greater than 30 minutes and the supporting documentation is present, you could use 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the evaluation and management (E/M). The key to billing for critical care is the documentation. (For more information on how to document for critical care, see the June 2000 ED Coding Alert Clarifying Critical Care Creates Reimbursement Opportunities, page 45.)

If the documentation is not adequate for 99291 (hopefully the caveat is invoked and documented) then it would possibly qualify for another level of ED visit (99281-99285). Either way, the undocumented wound care would be bundled with the E/M.