Pulmonology Coding Alert

Question: We got a lot out of your article last month regarding critical care coding, but we have a follow-up question. You said that critical care can be billed in any setting including the emergency department or a standard hospital room. What if the pulmonologist administers critical care in the office? Is that something we can bill with 99291?

Codify Subscriber

Answer:  Yes, you can report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) in the outpatient setting, as long as you meet the requirements of the code. The pulmonologist must be directly delivering medical care for a critically ill or critically injured patient, and must meet the time thresholds to bill the code.

For example, suppose a patient is doing a six-minute walk test in your hallway and goes into cardiac arrest. The pulmonologist administers critical care services for 30 minutes until the EMTs place her in an ambulance to take her to the hospital. In this situation, you can report 99291, assuming that the documentation supports the code.