ED Coding and Reimbursement Alert

Question: The ED physician treats a patient suffering from critical gastrointestinal hemorrhaging. Notes indicate that the physician took 28 minutes to perform gastric aspiration in order to determine the location of the bleeding and lavaging blood from the injury, and another 15 minutes stabilizing the patient. Is this a 99291 scenario? Are there any separately reportable services?

Illinois Subscriber

Answer: If your physician provided critical care in this scenario, it warrants one CPT code. On the claim, report the following:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care

• 578.9 (Hemorrhage of gastrointestinal tract, unspecified) appended to 99291 to represent the patient's condition.

Your description seems to indicate that the physician provided critical care, though you don't mention a specific critical care attestation. "Critical care is the direct delivery by a physician[s] of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition," according to CPT.

Best bet: Go back and check the notes to be absolutely sure that the encounter meets the guidelines for critical care before coding.

The total care for this patient was 43 minutes. The gastric aspiration and lavage are part of the critical care package, as is the stabilization, so don't report any of these services separately.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.