Pulmonology Coding Alert

Question: Please show us the best way to bill this claim. We have this type of claim often. Here’s what we plan to report:

• 99223 initial hospitalization E/M;
• 99291 critical care first hour;
• 99292 critical care additional over 60 mins;
• 31628 bronchoscopy;
• 31500 insert emergency airway

Can all these codes be reported for a patient on the same day?

California Subscriber

Answer: You can only bill 99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components…usually, the problem(s) requiring admission are of high severity. typically, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit) for the inpatient E/M if this service was performed and completed prior to the patient requiring critical care services.   Modifier 25 will need to be added to 99223, and the documentation must explicitly demonstrate the timing of event (i.e., the first encounter was provided prior to the initiation of critical care services. 
 

If the patient started out requiring critical care at the initial encounter by your physician, then only report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for critical care services provided for the first hour and +99292 (… each additional 30 minutes [List separately in addition to code for primary service]) for each additional thirty minutes of critical care services provided. Remember that 99291 cannot be billed for more than once in a day, and it will cover the services provided in the first hour.

Keep in mind:Along with these codes, any other separately identifiable procedure performed on the same day should be billed separately unless these procedural codes get bundled (as per Correct Coding Initiative [CCI] edits) into either the inpatient E/M codes or the critical care codes. However, since there is no bundling of the codes, you can report the emergency intubation using 31500 (Intubation, endotracheal, emergency procedure) and the bronchoscopy with 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe). Documentation for the critical care service should note that reported time did not include the time spent during these [separately billable] procedures.