EM Coding Alert

Question: One of the physicians in my office went to the emergency department to meet one of her patients who had an accident at home with a power tool. She was out of the ED within an hour. Can I use 99281-99285 for this service?

Maine Subscriber 

Answer: If your physician performed emergency services, the answer is yes. You would report the appropriate code from the 99281-99285 (Emergency department visit for the evaluation and management of a patient …) range, depending upon the documented level of service.

But if your physician provided critical care services, you would use 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 needed.

The patient would have to be in a possible life-threatening situation to use 99291-99292 and the physician must spend a minimum of 30 minutes with the patient and provide a high level of care until the patient is considered out of immediate mortal danger.

Never: You wouldn’t report a separate ED service if you report 99291-99292 for this encounter.

Critical care is described as when one or more vital organ systems is acutely impaired and there is a high probability of imminent or life-threatening deterioration of the patient’s condition, according to the CPT® guidelines. Critical care also includes the care of patients who might not be in a medical emergency but who nonetheless require constant physician attention because they are unstable and critically ill or unstable and critically injured.

Examples: Some conditions that might need critical care:

• Central nervous system failure
• Circulatory failure
• Shock
• Renal hepatic, metabolic and/or respiratory failure
• Overwhelming infection.