ED Coding and Reimbursement Alert

Question: A patient presented to the ED with shortness of breath and chest pain that had started one to two hours prior to coming to the hospital, and the pain had basically resolved when he arrived. The ED physician ordered an EKG and labs, which were both essentially normal. The patient had a prior history of CABG, so the plan was to admit the patient and check serial troponins. The doctor placed the patient on aspirin, beta blockers, Nitropaste, heparin and morphine. The patient was then hemodynamically stable, with oxygen saturation of 97 percent on 2 liters.
Does this meet the criteria for critical care (99291)? 


Delaware Subscriber


Answer: The definition of critical care in the 2005 CPT book requires that there is a high probability of imminent, life-threatening deterioration in the patient's condition. In this scenario, that does not appear to be the case.
 
The physician delivered excellent and prudent clinical care, but without active management of chest pain or EKG changes, the highest level ED E/M service (99285, Emergency department evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision-making of high complexity) might best represent the work performed.