Internal Medicine Coding Alert

Certain patient conditions could indicate 99291 service

Establishing critical illness or injury in a patient is vital to any claim in which you report critical care codes.

Given the litany of conditions that your internist might treat, it is difficult to discern whether a patient's condition is "critical," or if the physician's actions warrant reporting 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) or +99292 (... each additional 30 minutes [list separately in addition to code for primary service]).

Solution: Check out this list of conditions and physician actions that are commonly used in critical care scenarios. The list was provided by Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla.

If you see any of these indicators, you should probably start checking to see if the encounter satisfies critical care requirements -- but don't automatically report 99291 because the encounter contained elements of this list. These are indicators of critical care, not guarantees. When the encounter notes reveal one or more of these indicators, your internist might have provided critical care.

• Anaphylactic shock

• Angina, unstable, aggressive management

• Atrial fibrillation with tachycardia and hypotension

• Cardiac arrest

• Comatose/unconscious, unknown cause at presentation

• Diabetic ketoacidosis

• Glasgow coma scale below 14

• Head injury, severe, unresponsive

• Pulmonary edema, or emboli with unstable vital signs

• Septic shock

• Severe bleeding, requiring transfusion with unstable vital signs

• Shock-unresponsive patient

• Status asthmaticus

• Status epilepticus

• Stroke with unstable vital signs.

• Endotracheal intubation

• Thrombolytic therapy (TPA for cardiac or stroke)

• Cardioversion

• Defibrillation

• Thoracostomy

• Thoracentesis

• Pericardiocentesis

• CVP insertion

• Tracheostomy

• Cricothyroidotomy

• Abdominal paracentesis.