Gastroenterology Coding Alert

Find out whether this edit will allow a modifier

Good news: Gastroenterology escaped the brunt of the National Correct Coding Initiative (NCCI), version 12.3, but you still have one edit you should memorize.

If you need to report an emergency department (ED) visit as well as a critical care service (99291), you should keep in mind that a bundle prevents you from reporting both.

ED Visit, Critical Care Same Day? Count Only 99291

You should be wary of reporting ED visit codes 99281-99285 alongside critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). The ED visit is now a component of the comprehensive critical care service, and you can't separate this with a modifier -- no matter what, thanks to a modifier indicator of -0.-

-Cases where you would report an ED visit (99281-99285) with 99291 are rare, and I can see why payers would deny this,- says Dianne Wilkinson, RHIT, CCP, compliance officer and practice consultant for MedSouth Healthcare PC in Dyersburg, Tenn.

Example: A patient with abdominal pain presents to the ED, where the on-call gastroenterologist sees her. The patient undergoes an abdominal scan and laboratory tests, but when the patient begins vomiting blood, the gastroenterologist is called back to resume the care in the intensive care unit. The same on-call gastroenterologist admits her to critical care for 35 minutes in total. In this case, you should report 99291 only.