Neurosurgery Coding Alert

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

elaware Subscriber

Answer: If the patient required critical care during both encounters, bill 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]) for the total 90 minutes of critical care time on the same day.
 
However, if the patient did not require critical care at the initial encounter but then deteriorated (prompting the second visit), you should report the appropriate subsequent hospital care code (99231-99233) for the hospital visit and code 99291 for the second service.
 
Before billing for critical care, make sure you know that these services include the care of critically ill and unstable patients who require a high level of physician attention, whether the patient is in the course of a medical emergency or not, according to the Medicare Carriers Manual.
 
Your physician should provide decision-making of high complexity 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. For a patient with internal head injuries and the possibility of hemorrhage, the surgeon should be able to meet these criteria easily.
 
Typically, physicians administer critical care in a "critical care area," such as the coronary care unit, respiratory care unit or the emergency department. But Medicare (and possibly private carriers) will pay for critical care that a doctor provides in any location, as long you meet CPT and Medicare's guidelines.
 
And remember, just because the patient is in an intensive or 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 a critical care, intensive care, or other specialized care unit 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 period of time.