Gastroenterology Coding Alert

Question: An established patient presented to our practice thinking he was having severe heartburn, but the gastroenter­ologist determined he was having a heart attack and called 911 for immediate transport to the hospital. How should we code this emergency call?

Tennessee Subscriber

Answer: You should charge the insurer based on the actual services you performed, since CPT^® does not include any specific codes that describe having to dispatch emergency services. Therefore, in most cases, you will report the appropriate E/M code (typically 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient …).

If warranted, you would bill hourly critical care (99291- +99292, Critical care, evaluation and management of the critically ill or critically injured patient ...) while directly providing care for this critically ill patient based on time until the patient departs in the ambulance for the hospital. However, be sure that your documentation meets the requirements of the critical care codes before you report a code from this range.