Pulmonology Coding Alert

Stick to your guns: If your physician performs a separately billable procedure while rendering critical care, make sure you get paid for it. Although the 2003 CPT guidelines clearly state all the bundled procedures included in critical care, other private insurance companies sometimes try to bundle other services, says Nettie McFarland, RHIT, CCS-P, with Healthcare Billing Systems Inc.

If you receive denials for services not listed in the bundled services, appeal the claims and send your insurance companies regulatory information, McFarland says. The time and hassle are "worth the effort" because you usually receive correct reimbursement after the appeal, she says. These services are bundled under critical care: Indicator dilution studies for cardiac: 93561, 93562 Chest x-rays, one and two views: 71010, 71015, 71020 Pulse oximetry: 94760, 94761, 94762 Blood gases Information data stored in computers (including EKGs, blood pressures, hematologic data): 99090. Note, this bundle does not include 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) or 93042 (Rhythm ECG, one to three leads; interpretation and report only). Gastric incubation: 43752, 91105 Temporary transcutaneous pacing: 92953 Ventilatory management: 94656, 94657, 94660, 94662 Vascular access procedures: 36000, 36410, 36415, 36540, 36600.