Emergency Medicine Critical Care Billing & Coding

Touseef Riaz

April 26, 2022

Emergency Medicine Critical Care Billing & Coding

Emergency medicine critical care billing (EMCC) deals with critically ill patients both in the emergency department and the hospital. EMCC is a subspecialty of emergency medicine.

As the name suggests, critical care requires high complexity decision-making abilities to diagnose, manipulate and provide the needed treatment. This is the reason why emergency or critical care specialists are more focused on providing quality patient care.

Incorrect medical billing affects reimbursements and critical care emergency medicine billing. Services of critical care involve but are not limited to the following:

  • Central nervous system failure
  • Circulatory failure
  • Shock-like conditions
  • Renal failure
  • Hepatic failure
  • Metabolic failure
  • Respiratory failure
  • Postoperative complications

Emergency Medicine Critical Care Billing & Coding-ucontrolbilling.jpg

Along with those mentioned above, emergency medical specialist’s billing follows extensive interpretation and the use of advanced technology and techniques to treat patients. According to AAPC: “a critical care service is a service(s) provided to a patient in a “critical care area.” This area can include:

  • The coronary care unit (CCU)
  • Intensive care unit (ICU)
  • Respiratory care unit
  • Emergency room

Billing codes for Critical Care:

There are two time-based CPT codes for critical care used for billing critical care time emergency medicine. Critical care CPT codes are maintained by the American Medical Association (AMA) and fall under the code range of Critical Care Services.

Following are the CPT and HCPCS codes for emergency and critical care billing:

This code is applicable for critical care services. It includes evaluating and managing critically ill or critically injured patients for the first 30-74 minutes. The medical necessity for providing critical care services via proper documentation should be shown as it is an absolute requirement.

However, the appropriate level of E/M code should be used to bill any critical care service provided for less than 30 minutes.

Critical care, each additional 30 minutes. This is an add-on code; therefore, it must be used along with a primary CPT code (99291) beyond 74 minutes. After the first 30–74 minutes of direct critical care treatment, it includes the service. The medical necessity for providing critical care services via proper documentation should be shown as it is an absolute requirement.

“Trauma response team associated with hospital critical care service.” This code falls under Other Emergency Services and is maintained by the CMS.

How to use the CPT codes for critical care?

Following is the appropriate way to use the above-mentioned CPT codes for critical care:

Total Duration of Critical CareAppropriate CPT Codes
Less than 30 minutes99232 or 99233 or another appropriate E/M code
30- 74 minutes99291 x 1
75- 104 minutes99291 x 1 and 99292 x 1
105- 134 minutes99291 x 1 and 99292 x 2
135- 164 minutes99291 x 1 and 99292 x 3
165 – 194 minutes99291 x 1 and 99292 x 4
195 minutes or longer99291 – 99292 as appropriate

(based on the above-mentioned illustrations)

Reference: https://www.cgsmedicare.com/partb/pubs/news/2020/05/cope17364.html

Guidelines for Critical Care Billing Emergency Medicine:

Following are the emergency medicine critical care billing guidelines you need to follow:

  • Transesophageal echocardiography (TEE) monitoring (CPT code 93318) without probe placement is not separately reportable by a physician performing critical care E&M services.
    • However, if a physician places a transesophageal probe for TEE monitoring on the same date of service, the physician performs critical care E&M services. The CPT code 93318 may be reported with modifier 59 or XU.
    • The time necessary for probe placement shall not be included in the critical care time reported with CPT codes 99291 and 99292 as is true for all separately reportable procedures performed on a patient receiving critical care E&M services.
    • Diagnostic TEE services are separately reportable by a physician performing critical care E&M services.
  • Critical care E&M services (CPT codes 99291 and 99292) and prolonged E&M services (CPT codes 99354-99357) are reported based on time. Providers/suppliers shall not include the time devoted to performing separately reportable services when determining the amount of critical care or prolonged provider E&M service time.
    • For example, the time devoted to performing cardiopulmonary resuscitation (CPT code 92950) shall not be included in critical care E&M service time.
  • Per “CPT Manual” instructions, services not separately reportable by practitioners reporting critical care CPT codes 99291 and 99292, include the following but are not limited to
    • The interpretation of cardiac output measurements (CPT codes 93561 and 93562)
    • Chest X-rays (CPT codes 71045 and 71046)
    • Blood gases and data stored in computers (ECGs, blood pressures, hematologic data)
    • Gastric intubation (CPT codes 43752, 43753)
    • Temporary transcutaneous monitoring (CPT code 92953)
    • Ventilator management (CPT codes 94002-94004, 94660, 94662)
    • Vascular access procedures (CPT codes 36000, 36410, 36600).

However, facilities may separately report these services with critical care CPT codes 99291 and 99292.

  • Per “CPT Manual” instructions, practitioner inpatient neonatal and pediatric critical and intensive care services* include the same services included in critical care CPT codes*.
    • It also includes additional services listed in the “CPT Manual” specific to neonatal and pediatric critical and intensive care services.
    • These services shall not be reported separately by practitioners reporting CPT codes 99468-99480. However, facilities may separately report these services with CPT codes 99468-99480.
      • *Inpatient neonatal and pediatric critical and intensive care services s (i.e., CPT codes 99468-99480)
      • *Critical care CPT codes 99291 and 99292
  • Routine monitoring of ECG rhythm and review of daily hemodynamics, including cardiac output, are part of critical care E&M services. It is inappropriate to separately report the ECG rhythm strips and cardiac output measurements with critical care E&M services.
    • *CPT codes 93040-93042, 93561, 93562: ECG rhythm strips and cardiac output measurements
    • However, there is an exception to this principle. It may include:
      • If a diagnostic ECG rhythm strip and return to the critical care unit is required due to a sudden change in the patient’s status associated with a change in cardiac rhythm.
    •  If reported separately, the time for this service is not included in the critical care time calculated for reporting the critical care E&M service.
  • When CPT code 99175 is reported, observation time provided predominantly to monitor the patient for a response to an emetogenic agent shall not be included in other timed codes.
    • CPT code 99175: (Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison)

Fundamentals of Medical Billing and Coding:

Medical billing and coding are two crucial processes of healthcare practice. Both are necessary for getting reimbursements and the revenues for the healthcare services performed. Medical claims are created and billed to insurance payers/carriers to receive the proper reimbursements.

Medical coding deals with assigning specific codes to the billable information from a patient’s medical record. This process involves the use of commonly used medical coding systems, including

  • ICD 10 – International Classification of Diseases, 10th Edition:

ICD stands for International Classification of Diseases. ICD 10 is the 10th Edition of the ICD coding system and is published by the World Health Organization (WHO). This coding system comprises two medical code sets:

  • ICD-10-CM:
    • International Classification of Diseases, Tenth Revision, Clinical Modification
  • ICD-10-PCS:
    • International Classification of Diseases, Tenth Revision, Procedure Coding System
  • CPT – Current Procedural Terminology:

Current Procedural Terminology (CPT) codes are maintained by the American Medical Association (AMA). CPT codes are one of the most commonly used code sets and are further divided into several categories.

  • Category I:
    •  These are the most commonly used codes by medical coders to report medical services and procedures. Category I codes are five-digit numeric codes only, ranging from 00100 to 99499. CPT codes for critical care include CPT Code 99291 & CPT Code 99292.
    • This category comprises codes for performance measurement. Category II codes are supplemental tracking codes. These alphanumeric codes comprise four digits ending with an “F.” Category II codes are optional, meaning they are not required for proper medical coding. For instance:
      • Composite Measures
        • 0001F-0015F
      • Patient Management
        • 0500F-0575F
      • Patient History
        • 1000F-1220F
      • Physical Examination
        • 2000F-2050F
      • Diagnostic/Screening Processes or Results
        • 3006F-3573F
      • Therapeutic, Preventive, or Other Interventions
        • 4000F-4306F
      • Follow-up or Other Outcomes
        • 5005F-5100F
      • Patient Safety
        • 6005F-6045F
      • Structural Measures
        • 7010F-7025F
  • Category III:
    • This code set comprises temporary codes for emerging technology, procedures, and services. They are alphanumeric codes, four digits ending with a “T.
  • HCPCS – (Healthcare Common Procedure Coding System, Level II):

Healthcare Common Procedure Coding System (HCPCS) is another commonly used standardized coding system. HCPCS Level II procedure codes for healthcare providers, physicians, and medical equipment suppliers are for:

  • Medical devices
  • Supplies
  • Medications
  • Transportation services
  • Any other items or services

Outsourcing Medical Billing Services:

There are several errors and mistakes associated with medical billing and coding. These errors result in claim denials, late payments, lost revenues, and a lower reimbursement rate. Some of the most common medical billing and coding errors include

  • The use of incorrect code
  • The use of the wrong modifier
  • Incomplete or inaccurate documentation
  • Late submissions
  • Unbundling
  • Upcoding
  • Under coding

Even a minor mix-up in the code or not being up-to-date regarding the payer’s billing guidelines and requirements can result in claim denials. However, outsourcing medical billing services to a medical billing company can benefit the healthcare practice. Common benefits of outsourcing include:

  • Reduced errors in medical claims
  • A team of highly skilled professionals
  • Lesser claim denials or rejections
  • Timely submissions
  • Faster payments
  • Higher reimbursement rate
  • Improved revenue cycle

By outsourcing your medical billing services to Uncontrol Billing, you no longer have to worry about fixed costs.

Services offered by UControl Billing:

We offer:

  • Competitive and affordable pricing
  • Uninterrupted Service
  • Billing in 24 hours
  • Timely follow-ups
  • Reduced overall expenses
  • Maximized reimbursements
  • Improved Quality
  • Faster turnaround
  • HIPAA Compliant
  • Patient Support & Customer Services

Frequently Asked Questions (FAQs)

  1. What is emergency medicine critical care billing in medical billing?

Critical care billing emergency medicine billing deals with patients who are critically ill both in the emergency department and the hospital. Medical billing and coding for emergency medicine critical care are pretty challenging. The two most commonly used CPT codes for critical care include CPT Code 99291 & CPT Code 99292.

  1. What are common emergency medicine critical care billing errors?

Errors in urgent care revenue cycle management result in claim denials, late payments, lost revenues, and a lower reimbursement rate. Some of the most common emergency medicine coding errors include

  • The use of incorrect code
  • The use of the wrong modifier
  • Incomplete or inaccurate documentation
  • Late submissions
  • Unbundling, upcoding, and under coding
  1. What does emergency medicine critical care billing mean?

There are two time-based CPT codes for critical care used for billing critical care time emergency medicine. Critical care CPT codes are maintained by the American Medical Association (AMA) and fall under the code range of Critical Care Services. Following the emergency medicine practice management coding guidelines (mentioned above) is crucial for proper medical billing.

https://www.cgsmedicare.com/partb/pubs/news/2020/05/cope17364.html

https://www.cms.gov/files/document/chapter11cptcodes90000-99999final11.pdf

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