Oncology & Hematology Coding Alert

Question: If the oncologist uses radiation treatment to help a patient presenting with cord compression due to spinal column metastasis, may I report critical care codes?


Illinois Subscriber


Answer: The oncologist's services may merit critical care codes, but be confident the documentation supports your claim.

Spinal cord compression may lead to central nervous system failure, one of the diagnoses that may qualify for use of critical care codes 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]).

Documentation should report the exact critical care time and show that the oncologist gave his full attention to only the critical patient during the critical care time period. Careful: Only count time spent sustaining life functions toward the critical care time total. Don't count time spent on services you code separately, such as treatment planning, in the critical care time.

Note: If the critical care time does not amount to 30 minutes, report the appropriate E/M code instead and watch out for bundling issues for other services performed as part of the cord compression treatment.

The chart above shows how to properly report 99291-99292 based on time.