Orthopedic Coding Alert

Critical care codes sport higher relative value units (RVUs) than standard E/M codes. But be careful you don't miscode a claim in your zeal to use the high-RVU critical care codes. You could pay the price if auditors come knocking. Here's how to keep your claims in the clear.

Question: Should I report critical care services (99291-99292) when the surgeon visits a patient in the intensive care unit (ICU)?

Answer: If the surgeon treats a patient in the ICU, this is not a guarantee that critical care occurred, says Sandi Hamrick, CPC, of Toledo Orthopaedic Surgeons in Ohio.

According to CPT, a patient must be critically ill or injured to qualify for critical care services, which means a patient in which one or more vital organ systems is deteriorating, posing a life-threatening situation, Hamrick says.

Orthopedic surgeons are unlikely to perform critical care services. If for some reason the ICU visit isn't included in the global surgical package, look to subsequent hospital care codes (99231-99233) or hospital consultation codes (99251-99255) 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.