ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician performed 75 minutes of critical care for a patient, along with interpretation of a complete chest X-ray and ventilatory management. The chest X-ray interpretation and ventilatory management took an additional 18 minutes. How should I code for this encounter? Are the X-ray and vent management separately reportable?

Connecticut Subscriber

Answer: The X-ray interpretation and vent management are bundled into the critical care, meaning you have 93 total minutes of critical care to code. Choosing a code is going to depend on the payer, however.

Payers that follow CPT^® guidelines differ from those following guidance from the Centers for Medicare & Medicaid Services (CMS). CPT^® explicitly states that you can report the critical care add-on after the first 74 minutes of critical care. Since you are coding for 93 minutes, you’d report 99291 for the first 74 minutes of critical care and +99292 for the remaining 19 minutes.

CMS-observant payers, however, beginning in 2023 insist that you need 104 total minutes of critical care time before you can report the add-on code. For these payers, you’d only report 99291 for the entire encounter.

Best bet: If you have any doubt at all about what policy your payer follows, check your contract or contact a rep before coding.

1 more thing: The following services are bundled into 99291 and +99292:

• Interpretation of cardiac output measurements (+93598)
• Chest X-rays (71045, 71046)
• Pulse oximetry (94760, 94761, 94762)
• Blood gases, and collection and interpretation of physiologic data (e.g., ECGs, blood pressures, hematologic data)
• Gastric intubation (43752, 43753)
• Temporary transcutaneous pacing (92953)
• Ventilatory management (94002-94004, 94660, 94662)
• Vascular access procedures (36000, 36410, 36415, 36591, 36600)

“Any services performed that are not included in this listing should be reported separately,” according to CPT^®.