Pediatric Coding Alert

Question: One of our patients presented for a sick visit but was so ill that the pediatrician called 911 and had an ambulance come and take her to the hospital. Which CPT code should we report for this critical patient that required 911 dispatch?

Answer: You should charge the insurer based on the actual services you performed, since CPT does not include any specific codes that describe having to dispatch emergency services. But in cases when you are treating a critical care patient, you should bill the critical care codes.

You will charge the insurer with your E/M code based on the documentation the pediatrician recorded (typically 99214-99215 for an established patient).

In addition, you would bill hourly critical care (99291-99292) while directly providing care for this critically ill child based on time until the patient departs in the ambulance for the hospital.