ED Coding and Reimbursement Alert

Question: The parents of a 6-month-old girl brought her into the ED after she nearly drowned. The ED physician reported 35 minutes of critical care time, and the paramedics performed CPR. The doctor then transferred the child to another hospital. Usually I would report critical care code 99291 in a situation like this, but because the patient is only 6 months old, should I use 99293?

Washington Subscriber

Answer: According to CPT 2005, you should use codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) to describe any critical care service rendered in the emergency department, regardless of the patient's age.
 
Codes 99293 (Initial inpatient pediatric care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age) and 99294 (Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age) are only appropriate for use in the inpatient setting, not to describe ED services.