General Surgery Coding Alert

Question: Our surgeon performed 64 minutes of critical care for a patient in cardiac arrest. During the encounter, the physician also took a chest x-ray and performed ventilatory management. Can we report the chest x-ray and the ventilatory management separately?


Wisconsin Subscriber

Answer: In this case, you should report only the critical care service.
 
CPT guidelines bundle chest x-rays (71010, 71015 and 71020) and ventilatory management (94656, 94657, 94660 and 94662) into (not separately payable with) critical care codes (99291-99292).

On the claim, you should:

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

- link 427.5 (Cardiac arrest) to 99291 to represent the patient's cardiac arrest.

In fact, CPT bundles all of the following services into 99291 and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]):

- cardiac output measurements (93561, 93562)

- chest x-rays (71010, 71015, 71020)

- pulse oximetry (94760, 94761, 94762)

- information data stored in computers (such as electrocardiograms, blood pressures, hematologic data)

- blood gasses

- gastric intubation (43752, 91105)

- temporary transcutaneous pacing (92953)

- ventilatory management (94656, 94657, 94660, 94662)

- certain vascular access procedures (36000, 36410, 36415, 36540, 36600).

If the physician performs any of these services, you should not report them separately from the critical care.

ED codes are bundled: If the physician provides critical care services when a patient presents to the emergency department (ED), you should not separately report an ED services code (99281-99285).