Pulmonology Coding Alert

Question: A pulmonologist recently attended to a patient with chronic asthma in the intensive care unit (ICU). I reported 99291 for this encounter and was denied. Is this because the doctor did not spend more than 30 minutes at the bedside? Alabama Subscriber Answer: First, check your diagnosis code. Expect denials if the ICD-9 codes do not reflect the severity of the patient's condition to warrant critical care services. If you reported 493.20 (Chronic obstructive asthma; unspecified) the payer may not have felt that the patient met critical care criteria. It is more likely that the case would meet critical care criteria with a diagnosis of 493.22 (Chronic obstructive asthma with [acute] exacerbation), if the patient was indeed experiencing an exacerbation. Even in light of an "exacerbation," make sure the diagnosis is indicative of a condition warranting the physician's attention for at least 30 minutes. Consider this Medicare definition of [...]