Pulmonology Coding Alert

Question: When a pulmonologist provides care to a critically ill patient, can I always use critical care codes?

Georgia Subscriber

Answer: No. In addition to the pulmonologist documenting that the patient is critically ill, which means that the patient has at least one organ system that is failing and that the patient's life is in jeopardy without intervention, the critical care services must meet the critical care codes' time requirements.

The physician must provide and document critical care for 30 minutes before he can report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). Code +99292 is for each additional 30 minutes beyond the first 74 minutes. If the pulmonologist spends less than 30 minutes providing critical care to the patient, you have to choose another appropriate E/M code (such as subsequent hospital care codes, 99231-99233; or inpatient consultation codes, 99251-99255), depending on the service level the physician provided.

Tip: Critical care does not have to be continuous, but you should make sure your pulmonologist records the time he spends with the patient in the patient's chart and explains everything he did during that time. Critical care works on a calendar day. The physician can spend the time intermittently throughout the day, as long as she documents it. Documentation can be total time (such as 35 minutes) or start/stop times (for instance 0900-0935).

Do not count time that your pulmonologist spends performing separately reportable procedures as critical care time. Also, his critical care time should not overlap with any other provider's critical care time.

-- Answers to You Be the Coder and Reader Questions answered/reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Jill Young, CPC, president of Young Medical Consulting in East Lansing, Mich.