ED Coding and Reimbursement Alert

Question: The ED physician recently provided an extensive service for a critically ill patient who suffered an acute myocardial infarction (AMI). During the service, the physician performed the following services:

• Cardiopulmonary resuscitation (CPR)
• Cardiac output
• Electrocardiogram (ECG) interpretation and report
• Chest X-rays
• Pulse oximetry.
• Are all of these services considered part of the critical care package?

Montana Subscriber

Answer: Some of the services you list are part of the critical care service, while others are not.

Part of critical care: Cardiac output, chest X-rays, pulse oximetry.

Separate from critical care: CPR, EKG interpretation. When you file, be sure to submit 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]) and 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) to represent these services. On your claim, be sure to carve out the time that the physician spent on these separately reportable services.

For instance, let's say that the encounter you described lasted a total of 91 minutes; notes indicate that the physician spent 25 minutes administering CPR and 5 minutes on the EKG interpretation. On the claim, you should code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for 61 minutes of critical care (91-25-5 = 61).

Caveat: Before coding, add up to total number of critical care minutes for the session. If the physician did not provide at least 30 minutes of critical care for the patient, then you cannot report 99291 -- even if the patient was critically ill.