Practice Management Alert

Question: Our physician performed 64 minutes of critical care on a patient. During the encounter, he also performed pulse oximetry and ventilatory management. Can we report the pulse oximetry and the ventilatory management separately from the critical care?


Missouri Subscriber

Answer: In this scenario, you can only report the critical care service. According to CPT, pulse oximetry (94760, 94761, 94762) and ventilatory management (94656, 94657, 94660, 94662) are components of critical care and therefore not separately billable.

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

Also: CPT bundles the following services into critical care codes 99291 and +99292 (- each additional 30 minutes [list separately in addition to code for primary service]) when performed during the critical period by the physician providing critical care:
 
- interpretation of chest x-rays (71010, 71015, 71020)
- interpretation of cardiac output measurements (93561, 93562)
- gastric intubation (43752, 91105)
- temporary transcutaneous pacing (92953)
- vascular access procedures (36000, 36410, 36415, 36540, 36600)
- blood gases and other information stored in computers. For example, blood pressure, hematologic data, ECGs (99090).