tci E/M Coding Alert - 2020 Issue Q2

Reader Question: Be Critical of Using 99291 for Vent Management

Question: Our pulmonologist oversaw vent management for an inpatient last week and billed it as critical care, but the documentation doesn’t support the requirements for billing this way. He said the documentation of vent management will be enough to justify the 99291 coding. Is this true? Illinois Subscriber Answer: No, it isn’t. Do not make the mistake of reporting critical care services simply because the patient is on a ventilator or in the intensive care unit. The patient must meet all of the requirements for critical care from both CPT® and from the insurer’s policy requirements...

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