Gastroenterology Coding Alert

Question: One of my surgeons, who is a teaching physician, and a resident treated a patient with severe internal bleeding. They spent a total of 56 minutes of critical care time on the patient: 31 minutes to lavage excess blood from the intra-abdominal cavity, find the problem's cause, and stabilize the patient; and 25 minutes consulting with the patient and his wife. Can I report these services even though a resident was involved?

Wyoming Subscriber

Answer: Your surgeon may be able to report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), as long as the documentation supports the code.

Key questions: When filing teaching physician (TP) claims involving critical care, make sure the supporting documentation points out that the TP (the surgeon):

• treated the patient jointly with the resident

• directly supervised the resident for the full 56 minutes of treatment

• directly managed the patient's care

• referenced the resident's note in the documentation

• supervised the resident during the visit's history and exam

• noted a discussion with the resident concerning the blood removal, patient stabilization, and patient consult.

Tip: Residents can perform procedures on their own. But those procedures are not billable unless the fellow is not in a credentialed fellowship program and can bill under his own name and national provider identifier (NPI).

Also remember: The time the physicians spend providing critical care cannot be teaching time. The resident may be part of the care team, but you cannot count any time spent teaching the resident toward the time of critical care.

Additionally, any time spent performing separately billable procedures cannot be part of critical care time. While the lavage of excess blood is probably separately billable (49080, Peritoneocentesis ...), you can't count the time the physicians spend on that procedure toward critical care time.

Good practice: Encourage your physicians to specifically state "I spent X minutes providing critical care, excluding time spent teaching or providing separately billable services."