Neurology & Pain Management Coding Alert

Question: How should I code for the critical care of a stroke patient on Medicare? Maine Subscriber Answer: According to CMS, you should use 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) when all the criteria for critical care and critical care services are met. CMS CR 5993 Transmittal 1548, effective July 1, 2008, clarifies critical care as the care of a critical illness or injury that "acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition." Many stroke patients meet the criteria of being critically ill, as there is often a high likelihood of imminent, life-threatening deterioration. Take note: Even though your neurologist may not be considered the admitting physician, he may report critical care services for the time spent evaluating, providing care, and managing the critically ill or injured patient's care. And if more than one physician manages a different aspect of the patient's critical illness, each physician can potentially report the critical care services codes. The CMS transmittal points out, "Critically ill or critically injured patients may require the care of more than one physician medical specialty. Concurrent critical care services provided by each physician must be medically necessary and not provided during the same instance of time. Medical record documentation must support the medical necessity of critical care services provided by each physician." Heads up: Intravenous tissue plasminogen activator (IV tPA) therapy qualifies as critical care if it creates a high risk of a life-threatening intracranial bleed. tPA is the only FDA-approved drug for the urgent treatment of ischemic stroke.