Guide to Emergency Medicine Critical Care Billing
Emergency medicine critical care billing involves classifying and invoicing emergency intensive medical treatments for extraordinarily ill or injured patients. This specialized billing procedure includes rapid medical interventions, continuing monitoring, and sophisticated decision-making to stabilize life-threatening patients.
Key Components of Emergency Medicine Critical Care Billing
- Time-Based Billing
- CPT and ICD-10 Codes
- Modifiers
- Documentation
Common Challenges Faced by Healthcare Providers in Emergency Medicine Critical Care Billing
Complexity of Cases
The cases in critical care involve bleeding and, hence, are complex and varied, which counts documentation and coding a ’12. Some may have more than one procedure and several interventions and may take more time, which needs documentation and recording systematically and precisely.
Regulatory Compliance
One of the significant issues identified is the constant need to be on the lookout for new billing rules and regulations. Failure can result in payment not being made, follow-up audit & potential fines.
Time Constraints
Crisis goes hand in hand with the setting. For this reason, significant attention is paid to the patient rather than the paper in emergencies. This may cause several problems, such as improper documentation of bill details or costs that affect the claim processing decisions, including denials or delays.
Coordination with Payers
The issues of insurance, pre-authorization, and payer rules and regulations take a lot of time and effort to be resolved.
These Issues' Effect on Revenue and Patient Care
- Revenue Loss
- Administrative Burden
- Patient Care Continuity
- Provider Morale
Billing For Emergency Medical Specialists
To bill for emergency medical specialists, you need to know a lot about using and understanding new technologies and methods to help patients. The AAPC says critical care services are given to patients in a “critical care area.”
Some of these areas are:
- The heart care unit (CCU)
- The ICU stands for critical care unit.
- Respiratory/Lung care unit
- Emergency room
Codes for Emergency Medicine Critical Care Billing
CPT Codes for Critical Care Services
The codes come from Current Procedural Terminology (CPT) codes to capture the medical, surgical, and diagnostic services.
For critical care services, the following CPT codes are commonly used:
99291: This code pertains to the first 30-74 minutes of Critical Care attained by the general patient by a solitary day. ANAS includes tasks such as patient classification, developing treatment interventions, and organizing requisite services.
99292: This code is an add-on for each further 30 minutes of apprehensive consideration over and over again for 74 minutes. It cannot be reported separately, and its use is only possible if 99291 was also done on the patient.
HCPCS Codes for Critical Care
The Healthcare Common Procedure Coding System (HCPCS) includes codes for services, procedures, and equipment not covered by CPT codes. In critical care, HCPCS codes may complement CPT codes to give full billing details about the patient’s case.
G0390: This code is used in the trauma code and emergency intensive critical care and the purpose of life-threatening resuscitation.
ICD-10-CM Codes for Diagnoses
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes specify the diagnoses and conditions treated during critical care. Accurate ICD-10 coding is essential for justifying the need for critical care services.
R65.21: Severe sepsis with septic shock.
I21.3: ST elevation (STEMI) myocardial infarction of unspecified site.
J96.00: Acute respiratory failure, unspecified, whether with hypoxia or hypercapnia.
These diagnosis codes help convey the medical necessity and severity of the conditions treated in critical care.
Modifier Codes
Modifiers provide additional information about the services, helping clarify circumstances and enhance billing accuracy.
-25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.
-59: Distinct procedural service, indicating that a procedure or service was distinct or independent from other services performed on the same day.
Billing for Procedures and Interventions
Critical care often involves various procedures and interventions that must be documented and billed separately.
Examples include:
36556: Insertion of a non-tunneled central venous catheter.
31500: Intubation, endotracheal, emergency procedure.
Emergency Medicine Critical Care Billing Guidelines
- Transesophageal echocardiography (TEE) tracking (CPT code 93318) without probe placement is not something a doctor who does E&M services in critical care can report separately.
- On the other hand, if a doctor places a transesophageal probe for TEE tracking on the same day of the service, that doctor provides critical care E&M services. You can submit the CPT code 93318 with the 59 or XU modifier.
- When you report critical care time with CPT codes 99291 and 99292, the time it takes to place the probe is not included. This is also true for any other treatment that can be reported separately, such as when a patient receives critical care E&M services.
- A doctor who does critical care E&M services must report diagnostic TEE services separately.
- Service reports are based on time for critical care E&M (CPT codes 99291 and 99292) and long-term E&M (CPT codes 99354–99357). When providers and suppliers figure out how much critical care or delayed provider E&M service time they have, they can’t include the time they spend doing separately reportable services.
- For instance, the time spent on cardiac resuscitation (CPT code 92950) will not be counted as E&M service time in critical care.
- According to the “CPT Manual,” services that practitioners reporting critical care cannot report separately.
Revenue Cycle Management in EMS
EMS fees Revenue Cycle Management (RCM) includes all administrative and clinical tasks that gather, manage, and collect patient service fees. This complex procedure comprises patient registration, insurance verification, charge capture, coding, claims submission, payment posting, and accounts receivable follow-up. EMS RCM ensures healthcare professionals get paid appropriately and promptly.
Wrap-Up!
Maintaining a healthy revenue cycle and adequate emergency medicine critical care billing reimbursement requires foolproof and accurate billing.
It demands extensive knowledge of this field’s complex billing codes and laws. Healthcare providers can streamline billing and optimize income by working with EMS billing businesses and using revenue cycle management technologies.
HMS USA offers customized emergency medicine critical care billing options. Contact us today. Let us help you improve your practice and focus on patient care.
