tci ED Coding & Reimbursement Alert - 2003 Issue 12

Reader Question: Watch the Clock When Coding Critical Care

Question: A patient was brought into the emergency department with CPR in progress. Our physician assumed control of CPR administration once the patient entered the ED. I billed 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and was refused. Why isn't this considered critical care?Colorado Subscriber Answer: Time is the most likely culprit in this claim refusal. Check your documentation to see if critical care time was at least 30 minutes; if it exceeded 30 minutes, outside of any separately billable procedures, resubmit the claim with additional documentation attached...

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