Pulmonology Coding Alert

Question: We have just come across this claim. Initial Hosp. Consultation/ High Complex, Critical Care First Hr.; Critical Care additional over 60 mins.; Bronchoscopy; Insert Emergency Airway; all on the same day. How do I code this scenario?

Alabama Subscriber

Answer: A few more additional details are required to answer this query satisfactorily. You need to know whether both the inpatient consultation and the critical care (CC) service were provided by the same or different physician, with the same or different specialty and group practice), and the timing of each service. You have not mentioned the age of the patient, so this answer will assume that the patient’s age is more than 71 months. 

Usually you can bill both the high complex visit (99255, Inpatient consultation for a new or established patient, which requires these 3 key components: ….) for the consultation, and the CC service (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes, +99292 […each additional 30 minutes [List separately in addition to code for primary service]) on the same day. You have to confirm that the 2 visits were done on different time of the same day, and that the consultation preceded the critical care service. For example, the patient could have been stable during the initial consultative service, and later in the day, the physician was called to the unit do deal with the critical ill patient. 

Note: You cannot bill 99291 more than once on a single day. Using the code +99292 will depend upon the total time of CC service provided on a single day (each +99292 code for every additional 30 min after the first 30-74 min). It must be clearly documented that the critical care time did not include the time associated with any other services (preceding consult or procedures) provided to the patient that day.

Along with these codes, any other separately identifiable procedure performed on the same day, such as bronchoscopy (31628, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe) needs to be billed separately, and same goes for the code 31500 (Intubation, endotracheal, emergency procedure) also, provided the patient is considered as “adult” (more than 71 months of age).

Therefore, all the four codes can be used for billing on the same day, when the Consultation and Critical Care service is provided to an inpatient person aged 71 months or older. The submission will look like:

• 99291
• +99292
• 31628
• 31500.

Remember: You cannot use 31500 as a separate code in pediatric cases (when the patient is 29 days through 71 months of age). In that case, you should include 31500 within the CC service provided.