CODING & DOCUMENTATION
Answers to Your Questions
Fam Pract Manag. 2002 Feb;9(2):22.
Critical care on the day of admission
I recently admitted a Medicare patient for a deep vein thrombosis and performed the history and physical at noon on the day of admission. Later that day, the patient experienced anaphylaxis caused by an intravenous pain medication. I spent 105 minutes either at the patient’s bedside or on the floor dealing with his condition and preparing for a transfer to the ICU. The patient spent two days in the ICU and ultimately recovered without problems. Can I submit 99222 for the history and physical and critical care codes 99291 and 99292 for my management, even though they happened on the same day?
Yes, you may code and bill Medicare for both the hospital admission and subsequent critical care that occurred on the same day as long as you submit the appropriate documentation. According to CPT, “critical care and other [evaluation and management] E/M services may be provided to the same patient on the same date by the same physician.” The Medicare Carriers Manual states that “if there is a hospital or office/outpatient [E/M] service furnished early in the day and at that time the patient does not require critical care, but the patient requires critical care later in the day, both critical care and the [E/M] service may be paid.”
You may also want to add modifier -25 to 99222 to indicate that it was a significant, separately identifiable E/M service. Linking the specific diagnosis for each service to the appropriate CPT code will help identify the services as distinct. In your case, deep vein thrombosis is the diagnosis associated with the original admission and anaphylaxis is the reason for the critical care services.
Does a list of medication allergies constitute an element of “past, family and social history”?
Yes. CPT lists allergies as an element under past history, so listing patient allergies, noting that the patient has no allergies or noting that you reviewed a patient’s existing allergy list should constitute an element of past history. However, if the reason for the encounter is an allergic reaction to medication, this may be more appropriately listed as part of the history of present illness, rather than past history. Also, if the patient’s medication allergies are used as past history, you may not be able to count them as part of the review of systems for the allergic/immunologic organ system.
What is the CPT code for Denver developmental testing?
There is no CPT code specifically for Denver developmental testing. However, there are two codes for developmental testing in general: 96110 and 96111. Code 96110, “Developmental testing; limited (e.g., Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report,” should generally be used as a screening tool to identify children who should receive a more intense diagnostic evaluation or assessment. Code 96111, “Developmental testing; extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments, e.g., Bayley Scales of Infant Development) with interpretation and report, per hour,” may be used, for example, when a physician assesses a child and performs the administration, scoring, interpretation and reporting of the test. For less formal developmental testing or assessment, an appropriate E/M code may be used.
Kent Moore is the AAFP’s manager for health care financing and delivery systems and is a contributing editor to Family Practice Management.
Conflicts of interest: none reported.
These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Thomas A. Felger, MD, ABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; and P. Lynn Sallings, CPC.
Editor’s note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. Because CPT and ICD-9 codes change annually, you should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation and Management Services” for the most detailed and up-to-date information.
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Copyright © 2002 by the American Academy of Family Physicians.
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