ED Coding and Reimbursement Alert

Reader Questions:

Beware Bundled Services on Critical Care Claims

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).
 

Other Articles in this issue of

ED Coding and Reimbursement Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.