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Answer: Depending on what kind of chest x-ray the patient received and whether the physician analyzed the ECG, you may be eligible to submit multiple codes. It's easy to miss the opportunity in this case because the CPT mandates that for reporting critical care, a range of services must be included if the physician(s) performs them during the critical period. The long list of bundled services includes interpretation of cardiac output measurements (93561, 93562), chest x-rays (71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases and information data stored in computers (e.g., ECGs, blood pressures, hematologic data [99090]), gastric intubation (43752, 91105), temporary transcu-taneous pacing (92953), ventilator management (94656, 94657, 94660, 94662) and vascular access procedures (36000, 36410, 36415, 36540, 36600).
At first glance it does not look promising, but the CPT manual cracks open another door: "Any services performed which are not listed above should be reported separately." In other words, any CPT code not specifically listed can be coded. This means that you cannot code the following services because they are included in the definition of critical care: 71010 (Radiologic examination, chest; single view, frontal), 71015 (Radiologic examination, chest; stereo, frontal) or 71020 (Radiologic examination, chest, two views, frontal and lateral).
However, if the patient received a complete chest view, for example, you can code it separately: 71030 (Radiologic examination, chest, complete, minimum of four views).
Note: Other radiological codes that would be exempt from the critical care inclusion rule encompass 71021 (Radiologic examination, chest, two views, frontal and lateral; with apical lordotic procedure), 71022 (Radio-logic examination, chest, two views, frontal and lateral; with oblique projections), 71023 (Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy), 71034 (Radiologic examination, chest, complete, minimum of four views; with fluoroscopy) and 71035 (Radiologic examination, chest, special views [e.g, lateral decubitus, Bucky studies]).
Even though all of the above are chest x-rays, their codes are not included in critical care and you may ethically submit for reimbursement. The trick as always is to avoid categorical exclusions unless required to do so.
The same principle applies to the other patient care service referenced in your question. You cannot use code 99090 (Analysis of clinical data stored in computers [e.g., ECGs, blood pressures, hematologic data]) with critical care, but 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) is not listed as included so it can be coded separately.
And, CMS guidelines in the Carriers Manual support this interpretation. Chapter XV lists the codes that are not to be billed with critical care codes and then states explicitly: "No other procedure codes are bundled into the critical care codes. Therefore, other procedure codes can be billed separately."
Note: Remember that time spent performing any procedures that are not bundled into critical care and reported separately must be excluded from the time recorded as providing critical care. |
