Neurology & Pain Management Coding Alert

Question: My neurologist was performing a magnetoencephalogram and the patient went into respiratory arrest. The neurologist performed lifesaving critical care. Can I code for the critical care?

Massachusetts Subscriber

Answer: Yes, as long as your neurologist's documentation supports the critical care coding. The American Medical Association (AMA) CPT 2010 defines critical illness or injury as one 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."

Any physician can administer critical care at any time. In the event your neurologist provides critical care, you'll choose from the following codes:

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

+99292 -- ... each additional 30 minutes.

In the scenario above, you would report 95965 (Magnetoencephalography [MEG], recording and analysis; for spontaneous brain magnetic activity [e.g., epileptic cerebral cortex localization]) for the procedure. Then, for the critical care, report 99291 x 1, and possibly +99292 for additional time, based on the time your neurologist states he spent on critical care.

Important: The patient does not have to be in the intensive care unit (ICU) or the emergency department (ED) to receive critical care -- or for you to code it as such. Therefore, you should report critical care codes based on patient's condition, regardless of the location. It is important to document how and why the critical care occurred in an unusual setting, such as an MEG lab or an office.

Also note that just because a physician is treating a patient in the ICU or ED does not mean critical care occurred. Check notes from the encounter or query your neurologist before reporting 99291-+99292.

Your neurologist must document the time he spent with the critical patient in the record. Report the total time your neurologist spent providing critical care services that day, with that patient, even if the time is broken up throughout the day.

Finally, keep in mind that a number of services are included in reporting critical care, such as cardiac output measurements (93561, 93562), pulse oximetry (94760-94762), and blood gases. Check the CPT's guidelines in the E/M/Critical Care Services section for additional factors.