Pulmonology Coding Alert

Answer: Both the critical care and consultation codes are considered E/M services. To report both during the same day would be unusual. However, if a patient received a consult in the morning and then presented that afternoon in the ICU, you would use the critical care code appended with a modifier -25 to indicate that the consultation and critical care are two separate and different services, but appropriate under the circumstances.

Note that the critical care service codes depend on time. Use codes when:

1. You spent at least 30 minutes with the patient.

2. The patients condition is acute enough to justify using the critical care code based on its
description. Either the patient is sick enough to be
a critical care patient or she is not. If the patients
condition does not justify critical care acuity, then
the service performed is a consultation.

Editors note: Advice for the above questions was provided by Walter J. ODonohue, MD, FCCP, Creighton Chair, CPT/RUC Committee of the American College of Chest Physicians, representative to the AMA CPT Advisory committee for the American College of Chest Physicians, Chief, Pulmonary/Critical Care, University Medical Center, Pulmonary & CCM Division, in Omaha, Neb.