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Report chest x-rays, EKGs, and other procedures separately from critical care

APCs Weekly Monitor, September 7, 2007

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QUESTION: I would like to know how others are using the critical care codes in the emergency department. Do I have to bundle the technical side of the chest x-ray and the EKG procedures? The definition of critical care in the CPT Manual states that the "interpretation of .....chest x-ray," etc., is included in the critical care code.

ANSWER: Although the interpretation of chest x-rays, etc. are included in the professional billing of the critical care codes (99291 and 99292), CMS has specifically stated in a frequently asked question on its Web site that this rule does not apply to hospitals. CMS indicates that it has removed the national correct coding initiative edits for critical care for hospital services.

This means that the list of services that the CPT Manual indicates are included in critical care (e.g., a chest x-ray, etc.), are not bundled for hospital billing purposes. Since the hospital incurs costs for the technical component of such tests and procedures, you may bill these services separately from critical care.

Note that some of the items on the CPT Manual list are separately paid, and others are packaged for payment purposes, but you may report them all separately on the claim. For more information, see CMS frequently asked question 2392 on the CMS Web site here.

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