cpt 99291 vs. 99281-99284 ERcpt

what is best to bill when patient presents to ER as Truma. They are evaluated/treated and release. No admission require. Should critical care 99291 be billed or ER..

case: 20yr od found down questionable assault with blunted instrument. C/O right leg scrapy. postivie ETOH.(examination, labs, cxr & ct done) plan:repair scalp lac.adv.diet,repeat cpk and d/c.

cpt billed by Trauma physician 99284

critical care is only use if there is life threnthen organ system failure? correct?

Critical care...

For this I would use the ER codes (99281-99285) with place of service 23. Critical care notes have to have exact amount of time dictated and pretty much life threatening (critically ill/critically injured)

critical care versus ER codes

And if the patient is discharged home, they probably weren't critically ill, and so would not meet the requirements for critical care billing.

I have seen my ED docs

bill critical care for all kinds of silly things- asthma, chest pain, CHF exacerbation, etc. They claim the rules do not require constant bedside presence as they do with Inpatient and the time they spend calling the specialists, reviewing tests, etc qualify and that they truly spend 60-90 min on each patient and that these patients are critically ill. I have no faith that they are billing correctly...but they are independent practitioners so it's their career on the line.

critical care vs er

you are right, i am seeing the same thing and my feelings is once a patient has be evaulate and discharge would mean to me they where not critical ill, but the physician states they bill critical care for any patient that present with a life threathen multiple vital organ system failure and of course they throw in the time they spent.