Practice Management Alert

But carve out E/M time when adding up critical care minutes

When a physician provides critical care services, you can bill for an additional procedure or evaluation and management code--under certain circumstances.

When? Billers can report -other E/M services as long as they were performed prior to the critical care service,- says Linda Parks, an independent coding consultant in Marietta, Ga. But once critical care begins, any E/M service the physician provides is part of the critical care package.

For example, if a physician conducts a level-four E/M service for an established patient, then needs to provide critical care for 34 minutes, you may be able to bill both:

- 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity) for the E/M service

- and 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care.

Of course, you still need to include the proper documentation for your claim. Also, subtract the E/M time from the total critical care time, and document start and stop times for the critical care and the E/M service. (For more information on billing for critical care encounters, see -Count the Minutes to Keep Your Critical Care Billing Glitch-Free- included with this issue.)

Billers might also report additional codes on critical care claims if the physician provides a service that is not considered part of the critical care package, Parks says.

Example: The physician spends a total of 60 minutes performing critical care work. During this time, he performs CPR for 15 minutes. In this instance, you could report the CPR because it is not considered part of the critical care package and -the physician would still be able to bill 45 minutes of critical care time,- Parks says.

On the claim, you should:

- bill the critical care with 99291.

- bill the CPR with 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]).

On the claim, you will need to subtract the 15 minutes of CPR time from the total critical care time. Further, make sure your documentation includes start and stop times for the critical care and the CPR.