ED Coding and Reimbursement Alert

Question: If the ED physician responds to an inpatient code blue and performs critical care on the patient, should I report a critical care service or one of the subsequent hospital care codes? Documentation in the chart supports enough time for 99291.


Arkansas Subscriber

Answer: If you have adequate documentation to support billing a critical care service--including the time spent--report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). The codes representing subsequent hospital care (99231-99233) are appropriate in two cases:
 
- The physician's services didn't satisfy the definition of critical care, or

- The physician's services did provide critical care, but the documentation doesn't support the minimum time threshold for reporting 99291.

Of course that assumes you meet the documentation requirements of history, physical exam, and medical decision-making for the subsequent hospital codes as well.

Remember: Critical care services are more intensive and are represented by an appropriate increase in relative value units.