ED Coding and Reimbursement Alert

Question: Can we report critical care codes for a patient who isn't admitted to the hospital? The physician performed one lab and several x-rays, and the diagnosis could be a critical condition. The doctor marked "critical care 99291 or 99292" on t-sheet, and then discharged the patient.

Indiana Subscriber Answer: Yes, you can - there is no requirement that critical care patients be admitted for you to report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) or +99292 (... each additional 30 minutes [list separately in addition to code for primary service]). In fact, such situations are becoming more common with advancements in medical care, trends toward managing patients in an outpatient setting, and bed shortages.
 
Common examples include croup and allergic reactions, in which the patients are severely clinically distressed for a period of time, but then with aggressive treatment they recover completely and are ultimately discharged. Unfortunately, it's also true that some patients die before they can receive admission, despite the physician's care meeting the minimum time thresholds to bill critical care.