Gastroenterology Coding Alert

Question: The gastroenterologist treats a patient suffering from critical gastrointestinal hemorrhaging. Notes indicate that the physician took 28 minutes to  perform gastric aspiration in order to determine the location of the bleeding, 37 minutes lavaging blood from the injury, and 15 minutes stabilizing the patient. Can I report 99291 and +99292 for this encounter?

Illinois Subscriber

Answer: If your gastroenterologist provided critical care in this scenario, it warrants one code. On the claim, report the following:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care

• 578.9 (Hemorrhage of gastrointestinal tract, unspecified) linked to 99291 to represent the patient's condition.

Your description indicates that the gastroenterologist provided critical care, though there is a chance that the encounter did not meet all of the critical care parameters.

Check the notes to be absolutely sure that the encounter meets the guidelines for critical care before coding. While total critical care time for this encounter is 80 minutes, you should not include +99292 (... each additional 30 minutes [List separately in addition to code for primary service]) to account for the extra five minutes. Typically, to include +99292, the physician must provide at least 15 minutes of critical care beyond the first 74.