Health Information Management

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

APCs Insider, September 7, 2007

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular