EM Coding Alert

Question: A patient came into our office for a scheduled visit, and we sent him directly to the hospital for an outpatient test. On his way home, the patient became extremely ill, stopped back by our office, and then collapsed in the waiting area. We performed CPR and gave him oxygen. The emergency medical technicians arrived and transported the patient to the hospital. What codes should we report?

North Dakota Subscriber

Answer: If the physician provided an evaluation and management (E/M) service before sending the patient to the hospital, then you could choose the appropriate level E/M code for that service. Your options may include 99201-99205 or 99211-99215 (Office or other outpatient visit…, new or established patient), 99241-99245 (Office consultation …), or 99383-99387 or 99393-99397 (Preventive medicine services…, new or established patient) and then adding the time of the second visit to that initial documentation.

Or, depending on the documentation and the total time spent with the patient providing critical care, you may be able to code critical care (99291 or 99292) with the documentation of the original visit as well as the latter, unscheduled visit along with a separate CPR (92950) code when time is illustrated and the critical nature of the patient is evident.

Critical care occurs when a physician or other qualified healthcare professional directly provides medical services for a critically ill or critically injured patient. As always, the documentation must support the necessity of the critical care service. To qualify for critical care, a service must meet all of the following requirements:

• The patient must be critically ill/injured — have vital organ failure or a life-threatening health condition.
• The physician must perform the critical care services, including using high-complexity decision making to assess, manipulate, and support vital system functions to treat vital organ system failure or to prevent further life-threatening conditions.
• All critical care services must last at least 30 minutes on a given date of service. The time can be continuous or intermittent. But, for any given period of time the physician spends providing critical care services for a patient, he cannot provide services to any other patient during the same period of time.