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Pulmonology Coding Alert

Reader Question:

Know When You Can Report an E/M Service Along With Critical Care Services

Published on Sun Nov 25, 2012

Question: My doctor saw a new patient in the office (99205) and then decided to admit her to the ICU. When he saw the patient later that same day, he documented and billed 99291. How do we bill both procedures, so they are both paid?   New Jersey Subscriber Answer: There are certain circumstances during which you can bill an E/M service and the critical care services together. The first and foremost thing is that your doctor should have completed two separate services, the standard E/M service prior to the critical care services provided. So, if your physician performed all the components described by the descriptor of the E/M service prior to care provided in the ICU which lasted a minimum of 30 critical care minutes, you can bill both the services together. It is also important that all other guidelines for reporting critical care services should be met for you to report the services provided by your pulmonologist in the ICU using the critical services code, and not merely because the patient is located in the ICU. You will then be reporting 99205 ( Office or other outpatient visit for the evaluation and management of a new patient...) with the 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 it was a separate service and report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 30-74 minutes of critical care services provided. Instead, if the service began as a standard E/M but ended with critical care, you can only bill critical care services for this single encounter if it was provided for duration of more than 30 minutes or just claim compensation using the E/M services code if the time components and other requirements for a critical care service are not met.  

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