Revenue Cycle Insider

Question: I have a medical record that indicates the pulmonologist performed critical care services for a patient suffering from respiratory failure. The physician documented chest X-rays, ventilator management, pulse oximetry, and gastric intubation in the record.

Do I separately report each procedure in addition to 99291?

New York Subscriber

Answer: Physicians and other qualified healthcare professionals deliver critical care services for patients who are critically ill or injured. The injury or illness severely and negatively affects one or more vital organ systems that healthcare providers deem the conditions life threatening. Due to the urgent need to prevent further deterioration of the patient’s organs and condition, providers will deliver critical care to the patient.

Critical care services, billed with 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (… each additional 30 minutes (List separately in addition to code for primary service)), are bundled with several specific services. These individual services are considered essential to critical care and this means that you cannot report the services separately.

The services bundled into critical care services include:

• Vascular access procedures (36000, 36410, 36415, 36591, 36600)
• Ventilatory management (94002-94004, 94660, 94662)
• Interpretation of cardiac output measurements (+93598)
• Chest X-rays (71045-71046)
• Pulse oximetry (94760, 94761, 94762)
• Blood gases and physiologic data collection and interpretation
• Gastric intubation (43752-43753)
• Temporary transcutaneous pacing (92953)

If the physician performs any additional services that are not part of this critical care services list, then you should report the additional services separately.

Important: According to CPT^®, facilities can report the services listed above separately.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC