ED Coding and Reimbursement Alert
Leave Pediatric Codes Off Your CC Claim
Question: A father brings his 6-year-old child to the ED; according to encounter notes, the emergency medical technician said the patient had been "seizing for @least 30 min."During the history portion of the E/M, the physician discovers the child has a history of seizure disorders and the parents administered rectal valium without relief before dialing 911. The EMT administered intravenous lorazepam before driving the patient to the hospital. The patient required intubation secondary to respiratory failure, so the physician administered a propofol infusion for sedation and to control the seizures. The ED physician consults with a pediatrician, and the two agree that the patient should be admitted to the pediatric intensive care unit (PICU). The ED physician provided 90 minutes of critical care exclusive of the intubation. Should I report 99475 for this encounter? Minnesota Subscriber Answer: You should report the "standard" critical care codes for this encounter -- not 99475. 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 first 74 minutes of critical care +99292 (... each additional 30 minutes [List separately in addition to code for primary service]) for the remaining 32 minutes of critical care Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99291 and +99292(per payer policy) to show that the intubation and critical care were separate services 31500 (Intubation, endotrachael, emergency procedure) for the intubation service 345.3 (Epilepsy and recurrent seizures; grand mal status) appended to 99291, +99292, and 31500 to represent the patient's status epilepticus 518.81 (Other diseases of lung; other diseases of lung; acute respiratory failure) appended to 99291, +99292 and 31500 to represent the patient's respiratory failure Why not 99475? In fact, ED physicians should use 99291 and +99292 for all critical care services they provide, regardless of age. All of the daily neonatal (99468, 99469) and pediatric (99471, 99472, 99475, 99476) critical care codes are only used in the inpatient setting.
ED Coding and Reimbursement Alert
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