Pulmonology Coding Alert

Critical care codes don't include all additional E/M services, so get paid for both on the same date of service.

The physician who provides critical care, reported as 99291 ( first 30-74 minutes) and +99292 ( each additional 30 minutes), may also render separately billable E/M services to the same patient on the same date, according to CPT. You therefore can report a separate E/M service, for example subsequent hospital care (99231-99233), provided to a patient before her condition changed and required critical care, says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa. Medicare, however, will not pay for an E/M service performed after critical care on the same date of service, though it does pay the critical care, whether or not it occurs before an E/M service.

If you report critical care and a separate E/M service for the same date, remember to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same it to the E/M service before critical care. If the physician performs critical care on a date during the postoperative period of a procedure, append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the critical care service, she adds. You will also need to report separate diagnosis codes for separate E/M visits, Grider says. For example, if a patient has chest pain and shortness of breath in a hospital unit and later that day the patient goes into respiratory failure requiring critical care services, report the signs and symptoms of chest pain (786.52) and shortness of breath (786.05) for the first visit and respiratory failure (518.81) for the second service, she says. You can report critical care for your pulmonologist even if another physician provides critical care to the same patient on the same date of service, Grider says. For example, your physician manages the respiratory failure, and the cardiologist manages the myocardial infarction. As long as these two physicians' services do not occur during overlapping times, they are both reportable. Report your physician's critical work because it was medically necessary.