EM Coding Alert

Question: The critical care unit called the emergency physician at 4 a.m. to see a patient with congestive heart failure who suffered acute respiratory failure and was placed on a ventilator two hours earlier. The physician performed a history and physical exam and reviewed lab work, blood gases, ongoing laboratory studies, and consultants' notes and recommendations for that patient's ongoing treatment. The physician documented the ventilator settings and, based upon the recent blood gases, he made an adjustment to the ventilator settings, along with the data necessary to provide the initial day of ventilator care. The notes indicated 12 minutes of ventilator management. In order to further stabilize this critically ill patient, the physician spent another 48 minutes providing critical care services including adjusting several intravenous vaso-active medications and changing the patient's antibiotics. What CPT^® code should we report?

Florida Subscriber

Answer: A critical care code is a better representation of the physician's cognitive effort. In this case the highly complex bedside work involved reviewing significant data for a critically ill patient and adjusting the ventilator setting. So, since the physician provided critical care for the patient, add up total session minutes (48 + 12 = 60) and report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the physician's services.