Neurology & Pain Management Coding Alert

Question: In the afternoon, our neurologist saw a patient for 30 minutes on the hospital floor, and in the evening he transferred the patient to the intensive care unit. There, the physician provided 60 minutes of critical care with the patient. How should I code this? The neurologist says there should be more than one code because he wants to get paid more for his extra time and work.


Delaware Subscriber

Answer: You should report the appropriate subsequent hospital care code (99231-99233) for the hospital visit. For the critical care services, you should assign 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes).

Before you bill for critical care, make sure you know that critical care includes the care of critically ill and unstable patients who require constant physician attention, regardless of whether the patient is in the course of a medical emergency, according to the Medicare Carriers Manual. Your physician should provide high-complexity decision-making to assess, manipulate and support circulatory, respiratory, central nervous, metabolic or other vital system function to prevent or treat single or multiple vital organ system failure.

Typically, physicians administer critical care in a "critical care area," such as the coronary care unit, respiratory care unit or the emergency department. But insurers, including Medicare, will pay for critical care that a doctor provides in any location as long as you meet CPT and Medicare guidelines.
 
But remember, just because the patient is in a critical care unit doesn't mean you can automatically report 99291.

You should report services for a patient who is not critically ill and unstable but who happens to be in critical care, intensive care or other specialized care, using subsequent hospital care codes (99231-99233) or hospital consultation codes (99251-99263). In addition, for a physician to bill critical care, he must devote his full attention to the patient and, therefore, cannot render E/M services to any other patient during the same time period.