Neurosurgery Coding Alert

Question: A patient presenting for evaluation of carpal tunnel syndrome experienced anaphylactic shock due to an allergic reaction she had while in our office. The neurosurgeon provided care until an ambulance arrived. Should we report this service using the emergency department codes?


Wyoming Subscriber

Answer: No. You can only use the emergency department service codes (99281-99285, Emergency department visit for the evaluation and management of a patient ...) for services your physician provides in a hospital-based setting.

CPT specifies that -an emergency department is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention.- In other words, you can't use 99281-99285 for emergency care that your physician provides in the office.

You should submit 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) or a normal office visit code (for example, 9921x, Office or other outpatient visit for the evaluation and management of an established patient ...) in this situation. Which one you choose depends on the severity of the shock and how long your neurosurgeon had to provide care.

Beware: For you to report 99291, there needs to be -a high probability of imminent or life-threatening deterioration in the patient's condition,- CPT states. CPT also states that -the physician must devote his or her full attention to the patient and, therefore, cannot provide services to any other patient.-

Also remember that, as the code descriptor indicates, your neurosurgeon must have spent 30 minutes providing the critical care service to the patient. If the ambulance arrived after only 10 minutes, you won't be able to use 99291. You physician's careful documentation of the critical care time is essential to be able to report this code.

Bonus: If your neurosurgeon finished his E/M service for the carpal tunnel syndrome (354.0) evaluation before the anaphylactic episode, report the appropriate E/M service code along with the critical care code. Append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M service code to indicate that the services were separate.