Pulmonology Coding Alert

Certain patient conditions could indicate 99291 service

Establishing critical illness or injury in a patient is vital to any claim in which you report critical care codes.

But at times it is difficult to discern whether a patient's condition is really "critical," or if the physician's actions warrant reporting 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) or +99292 (... each additional 30 minutes [list separately in addition to code for primary service]).

Solution: Check out this list of conditions, medications and physician actions that are commonly used in critical care scenarios. The list was provided by Caral Edelberg, CPC, CCS-P, CHC, president of Medical Management Resources for TeamHealth in Jacksonville, Fla.

Warning: These are indicators of critical care, not guarantees. When the encounter notes reveal one or more of these indicators, your pulmonologist might have provided critical care.

If you see any of these indicators, you should probably start checking to see if the encounter satisfies critical care requirements--but don't automatically report 99291 because the encounter contained elements of this list.
 
Symptomatic Indicators of Critical Care
 
• Acidosis
• Anaphylactic shock
• Asthma, multiple treatments with more risk
• COPD severe exacerbation
• Dehydration with significant metabolic/blood chemistry changes
• Hypoxia/hypoxemia
• Unstable vital signs
• Hypernatremia
• Pneumothorax
• Pulmonary edema, or emboli
• Sepsis/septicemia
• Severe bleeding, requiring transfusion
• Shock-unresponsive patient
• Status asthmaticus.
 
Management Indicators of Critical Care
 
• Use of anti-arrhythmics such as: adenosine, atropine, bretylium, cardizem, inderal, lidocaine, digitalis, procainamide, lopressor, amiodarone, flecainide, etc.
• Use of vasopressors such as: dopamine, epinephrine, norepinephrine, phenylephrine, etc.
• Use of vasodilators such as: nitroglycerine, nitroprusside, captopril, etc.
• Use of inotropic agents such as: dobutamine, dopamine, isoproterenol, etc.
 
Procedural Indicators of Critical Care

• Endotracheal intubation
• Thoracostomy
• Thoracentesis
• CVP insertion
• Tracheostomy
• Cricothyroidotomy.