ED Coding and Reimbursement Alert

Question: A patient was brought into the emergency department with CPR in progress. Our physician assumed control of CPR administration once the patient entered the ED. I billed 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and was refused. Why isn't this considered critical care?

Colorado Subscriber
 
Answer: Time is the most likely culprit in this claim refusal. Check your documentation to see if critical care time was at least 30 minutes; if it exceeded 30 minutes, outside of any separately billable procedures, resubmit the claim with additional documentation attached.
 
If critical care time wasn't at least 30 minutes, you should report 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) and the appropriate E/M code from the 99281-99285 series (Emergency department visit for the evaluation and management of a patient, which requires three key components) based on the documentation provided.  - Reader Questions and You Be the Coder were reviewed by Mike Granovsky, MD, CPC, FACEP, chief financial officer of Greater Washington Emergency Physicians in Fort Washington, Md.