EM Coding Alert

Question: The patient reported to the emergency department (ED) in respiratory distress. He is a three-packs-a-day smoker with a diagnosis of chronic obstructive pulmonary disease (COPD). The physician administered breathing treatments and monitored the patient's oxygen saturation and blood gases. During the entire encounter, the physician was either at the patient's bedside or at the nurse's station monitoring the patient for respiratory or cardiac arrest. The total encounter time was 104 minutes. How should I code for this situation?

Ohio Subscriber

Answer: Since the notes indicate the physician spent all 104 documented minutes of the encounter exclusively stabilizing this critically ill patient, the whole period of time is considered critical care, provided the documentation also illustrates the critical nature of the patient's condition as you indicate.

You could 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)) for the critical care service, and include the following diagnoses in this order to fully depict the patient's critical condition:

• J80 (Acute respiratory distress syndrome)
• J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation)
• F17.210 (Nicotine dependence, cigarettes, uncomplicated).

Remember:  As critical care time increases, so would the quantity of 99292 units you can report. For every 30 minutes after the first 74 minutes of critical care, you can report another unit of 99292. The quantity billed field should indicate how many 30-minute segments the provider performed and documented.