ED Coding and Reimbursement Alert

Question: In the December 2002 issue of ED Coding Alert, you discussed new pediatric critical care codes and 2003 changes. Would you please clarify whether an ED physician can actually charge for critical care services using the new codes (99293 and 99294)? As stated, those charges are calculated by day rather than by minutes as codes 99291 and 99292 are. Also, if the new codes are billable, can more than one provider bill for those services on a given date? Judging by our experience, these codes appear to apply to inpatient services only.

Florida Subscriber

Answer: Sorry for the confusion. To clear up this issue: CPT stipulates that you should report codes 99293 (Initial pediatric critical care) and 99294 (Subsequent pediatric critical care) when the patient receives a full day of service. Consequently, both codes are typically appropriate on the inpatient critical care wards. Instead of these codes, physicians in the ED should continue to use 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes) for critical care services rendered to patients of all ages.