ED Coding and Reimbursement Alert

Question: A patient with a stated diagnosis of obstructive sleep apnea is rushed to the ED via ambulance; she is unconscious and her breathing is uneven. During the E/M service, the ED physician determines that the patient is suffering acute respiratory failure. He then performs 20 minutes of continuous positive airway pressure (CPAP) to stabilize the patient. Total encounter time is 46 minutes. Notes indicate that the patient was suffering from a critical illness, and the physician provided uninterrupted service during the encounter. Is this a 99291 scenario?

Louisiana Subscriber

Answer: The ED physician exceeded the 30-minute minimum required for critical care, so you can report 99291 in this instance. 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

" 518.81 (Acute respiratory failure) appended to 99291 to represent the patients respiratory failure

" 327.23 (Obstructive sleep apnea [adult] [pediatric]) appended to 99291 to represent the patients apnea.

Explanation: You should include the time the physician spent on CPAP (94660 [Continuous positive airway pressure ventilation (CPAP), initiation and management]) toward total critical care time, as 94660 is bundled into 99291 and +99292 (& each additional 30 minutes [List separately in addition to code for primary service]).