ED Coding and Reimbursement Alert

Question: The ED physician treats a patient suffering from respiratory distress. Notes indicate the patient is acutely dyspneic and requires intubation, which is technically difficult. The intubation takes 20 minutes with various attempts and devices employed. Ultimately, the patient is successfully intubated and placed on a ventilator. The physician also places a central line, which takes 18 minutes. The encounter notes count 94 total minutes. Should I report 99291 and a unit of +99292?

Iowa Subscriber

Answer: No, you should report only 99291. On your claim you would report the following CPT codes:

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

• 31500 (Intubation, endotracheal, emergency procedure) for the intubation

• 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) for the central line placement.

The math: In this scenario, you must carve out the time the physician spent performing separately billable  procedures: subtract the 38 minutes spent performing the intubation and the central line from 94, leaving 56 minutes of critical care to report.