Pulmonology Coding Alert

Question: During morning rounds, I saw a patient with respiratory failure, aspiration, pneumonia and malnutrition who was on a ventilator. I coded this encounter as 99233. She was extubated after I left but failed extubation. I returned to her bedside, saw she was doing poorly, reintubated her and put her back on the ventilator. How would I code this scenario?

Missouri Subscriber

Answer: Code for the intubation with 31500 (intubation, endotracheal, emergency procedure) and report the critical care (99291-99292) time independent of the intubation time. This should be reported in addition to your earlier visit. Your documentation should include the total time at the patients bedside.

Another approach to consider depends on the total time spent with the patient and recorded in the chart. Critical care lasting less than 30 minutes should be coded with the appropriate evaluation and management codes (e.g., 99233). If the total critical care time exceeds the 30-minute threshold, use 99291 (critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). You also should use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate that the critical care was separate from the work associated with the intubation.


Reader questions are answered by Michael S. Haynes, MD, FCCP, compliance officer at University Medical Associates, a multispecialty physician medical practice in Augusta, Ga.; Carol Pohlig, CPC, RN, a reimbursement analyst for the office of clinical documentation in the department of medicine at the University of Pennsylvania in Philadelphia; and Walter J. ODonohue Jr., MD, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative to the AMA CPT advisory committee for ACCP.