Neurosurgery Coding Alert

Question: Our physician spends a total of 115 minutes caring exclusively for a critically injured patient in the ER who has suffered a stroke of the carotid artery. Our physician ordered rapid sequence intubation to facilitate breathing, and uses a sequence of drugs during the intubation: 5 mg of intravenous Versed and 150 mg of IV succinylcholine. The intubation took 16 minutes, and the physician spent the other 99 minutes of the encounter time at the patient’s bedside or conversing with his wife to get medical information the patient cannot provide. Can we code the intubation and critical care separately? 

New Hampshire Subscriber

Answer: You can code for the critical care and intubation; the drug supply codes are a no-go, though. On the claim, report the following:

• 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 74 minutes of critical care
• +99292 (… each additional 30 minutes [List separately in addition to code for primary procedure]) for the remaining 25 minutes of critical care
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99291 and possibly +99292 depending on the payer to show that the critical care and intubation were separate services.
• 31500 (Intubation, endotracheal, emergency procedure) for the intubation
• 433.11 (Occlusion and stenosis of carotid artery with cerebral infarction) appended to 99291, +99292, and 31500 to represent the patient’s stroke.

CPT® lists a number of services that are included in critical care services, such as ventilator management. However, intubation is not among these and is separately reportable.