ED Coding and Reimbursement Alert

Question: Our ED physician performed 64 minutes of critical care on a patient in cardiac arrest. During the encounter, the physician also took a chest x-ray and performed ventilatory management. Can we report the chest x-ray and the ventilatory management separate from the critical care?

Minnesota Subscriber

Answer: In this scenario, you can only report the critical care service. According to CPT, chest x-rays (CPT codes 71010, 71015, 71020) and ventilatory management (94656, 94657, 94660, 94662) are bundled into critical care codes.
 
On the claim, you should:
 - report 99291 for the critical care
 - attach ICD-9 code 427.5 (Cardiac arrest) to 99291 to represent the patient's cardiac arrest.

CPT also bundles these services into 99291 and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]): interpretation of cardiac output measurements (93561, 93562), pulse oximetry (94760, 94761, 94762), blood gases, and information data stored in computers (99090); gastric intubation (43752, 91105); temporary transcutaneous pacing (92953); and vascular access procedures (36000, 36410, 36415, 36540, 36600).