Pulmonology Coding Alert

3 scenarios from our coding experts help you improve your 99291 skills

No pulmonology practice wants to go to the trouble of filing a critical care claim only to have it rejected. Consider these scenarios and ask yourself: Should I report a critical care code in this situation? Write down your responses before looking to the correct answers on page 86.
 
Scenario 1: The pulmonologist documents 53 minutes tending to a critically ill patient, during which she performs CPR. In her notes, the pulmonologist points out that CPR took 17 minutes, with the rest of the time devoted to critical care services.
 
Scenario 2: The pulmonologist documents 45 minutes of critical care time, during which she performed CPR and ventilatory management. The pulmonologist provides no other statements or documentation.
 
Scenario 3: The pulmonologist's documentation notes 43 minutes with a critically injured patient, during which she inserted a chest tube and central line. In her notes, the pulmonologist reports that the chest tube and central line procedure took 18 minutes, and she devoted the rest of the time to critical care services.


 Experts provide the answers

Answer 1: Yes, you can report a critical care code (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). The pulmonologist made it very easy for her coding office, taking care to note that the separately billable services (CPR) accounted for only 17 minutes of the visit, leaving 36 spent on critical care.
 
Answer 2: Based on the documentation the pulmonologist provided, you should not bill for critical care services along with CPR and ventilatory management. The pulmonologist provides no documentation to prove that the pulmonologist spent at least 30 minutes administering critical care. In this case, query the pulmonologist to clarify the time spent performing the separate procedure (in this case, CPR: remember, ventilatory management is included in critical care) and document this time accordingly. Develop a consensus with the pulmonologist group for cases like this, which could then become part of your compliance plan, coding experts say.
 
Answer 3: No, you cannot report a critical care code. The pulmonologist's documentation indicates she spent only 25 minutes providing critical care services represented by the critical care codes.