ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the physician provided 23 minutes of critical care. Can I code this as critical care with modifier 52 appended?

Arizona Subscriber

Answer: Absolutely not.

First, you need a minimum of 30 minutes of critical care time in order to report 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)). Second, modifier 52 (Reduced services) is a procedural modifier, meaning you cannot use it on evaluation and management (E/M) codes.

Do this: Choose the appropriate code from the 99281 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making.) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity.) code set. This encounter will almost certainly be a 99285, but always code to the notes.

Remember: When you’re counting up critical care minutes, you should count these services toward critical care time; do not code them separately:

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

“Any services performed that are not listed above should be reported separately,” per CPT^® 2022.