EM Coding Alert

Don’t be fooled by interventions that are separately reportable from 99291/99292.

It isn’t always easy to spot claims where you can rightfully report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and 99292 (… each additional 30 minutes [List separately in addition to code for primary service]). If a patient is deemed critically ill or injured, no matter the condition, then they might have received (codeable) critical care.

One expert’s take: Someone who’s seen a lot of critical care claims is Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, founder and chairman of Edelberg + Associates in Atlanta.

Cut out this list Edelberg compiled, which identifies some situations in which the provider might perform critical care, and place a copy wherever someone might consider critical care codes.

These aren’t automatic critical care situations, however. This list represents “interventions requiring high medical-decision making to manipulate and/or support critical patient conditions,” Edelberg explains. The physician’s documentation around the severity of the patient’s condition along with the time spent providing critical services will determine the use of these codes.

Caveat: These interventions are merely markers, and not intended to be a comprehensive list of 99291/99292 encounter types. Further, some of these interventions are separately reportable from 99291/99292. (CPR, for example). For more information on separately reportable services, see the explanation below the code descriptor for 99291 in CPT^® 2016:

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POTENTIAL CRITICAL CARE INTERVENTIONS

• Administration of critical care medications
• Administration of activated charcoal
• Aerosol or nebulizer treatments, ≥ 3 or continuous
• Advanced cardiovascular life support (ACLS) or cardiopulmonary resuscitation (CPR)
• Cardioversion, chemical or electrical
• Chest tube placement, thoracostomy
• Consult with another provider
• Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP)
• Endotracheal intubation or rapid sequence intubation (RSI)
• Fasciotomy or escharotomy
• Gastric lavage
• Insertion of gastrointestinal (GI) tube
• Insertion of non-tunneled catheter
• Placement of an intraosseous intravenous (IV) line
• Intravenous infusion (“rapid” or “bolus,” with 2 more liters of fluid [adult], or 20cc/kg [pediatric patients]
• Lumbar puncture (spinal tap)
• Multiple IV or intramuscular (IM) medications, infusions, and/or antibiotics
• Multiple labs or ancillary studies
• Administration of oxygen (high-flow, by mask, 100% non-rebreather, or ≥ 40% Venti mask)
• Insertion of pacemaker (internal or external)
• Pericardiocentesis
• Advanced studies (Computed tomography [CT] scan, magnetic resonance imaging [MRI], sonography, etc.)
• Suctioning of mouth, throat
• Tracheotomy or cricothyrotomy
• Patient transfer or admission to catheterization laboratory (cath lab), critical care unit (CCU), operating room (OR), pediatric intensive care unit (PICU), surgical intensive care unit (SICU), or another facility for care
• Transfusion of blood or blood products (for example fresh frozen plasma (FFP); platelets, packed cells, Factor VIII, whole blood) in emergency department (ED)
• Administration of universal (O-) blood 
• Ventilator management.