Internal Medicine Coding Alert

Question: We had a patient suffer syncope and collapse in the office. We administered oxygen, and the doctor provided one-on-one care until the paramedics arrived. How should we code for oxygen administration in the office? Are there other codes we could use?

New Hampshire Subscriber

Answer: There is no code for administration of oxygen. This service is included in the E/M service. The physician should bill the appropriate level of E/M that describes the service that he or she performed.

Depending on the services provided, the condition of the patient, and how long it took the paramedics to arrive, you will most likely bill an office visit code (99201-99215). You might be able to use a critical care code (99291-99292), but the described encounter does not sound as if it will meet the criteria. For you to use a critical care E/M code, the patient must meet the definition of "critically ill or injured" as defined in the CPT guidelines. In addition, the physician must have spent at least 30 minutes of face-to-face time with the patient prior to the paramedics taking over care.

Answers to You Be the Coder and Reader Questions were provided by Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.; Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company; and Judy Richardson, RN, MSA, CCS-P, a senior consultant at Hill and Associates, a coding and compliance consulting firm in Wilmington, N.C.