Health Information Management

Do not report emergency department (ED) E/M codes in addition to critical care codes on the same claim

APCs Insider, November 2, 2007

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QUESTION: I was wondering if you could address when it is appropriate to bill ED E/M codes (99281-99285) and critical care codes (99291-99292) on a claim at the same time. With a status indicator of "S," it would appear that critical care is distinct from the E/M codes.

ANSWER: You cannot report a critical care code with a code for a medical visit or for an ED service. According to the April 7, 2000 issue of the Federal Register Volume 65, Number 68, Rules and Regulations, CMS states: "We proposed paying for critical care as the highest level of ''visit.'' In our proposed rule, we stated that hospitals would use CPT code 99291 to bill for outpatient encounters in which critical care services are furnished. We used the CPT definition of ''critical care,'' which is the evaluation and management of the critically ill or injured patient. Under the outpatient PPS, we would allow the hospital to use CPT code 99291 in place of, but not in addition to, a code for a medical visit or for an emergency department service."



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