Question

question 12

a 25-year-old male is brought by ems to the emergency department for nausea and vomiting. patient has elevated blood sugars and the ed is unable to get a history due to patients altered mental status. a medically appropriate exam is performed, and the mdm is high. the patient stabilized and transferred to icu under a different provider. the ed provider documents total critical care time 25 minutes. what cpt® code reported?

99223-25, 99291
99285
99285-25, 99291
99291

Explanation:

Analyze critical care time requirements

According to CPT guidelines, critical care services (CPT 99291) require a minimum of 30 minutes of total critical care time on a given date. Since the provider documented only 25 minutes of critical care time, critical care codes (99291) cannot be reported.

Determine the appropriate E/M service level

Because the critical care time is less than 30 minutes, the service must be billed using the appropriate Evaluation and Management (E/M) code. The patient was evaluated in the Emergency Department (ED) with high Medical Decision Making (MDM). The highest level ED E/M code is 99285, which is defined by a medically appropriate history and/or examination and high MDM.

Answer:

• (A) 99223-25, 99291
• (B) 99285 (Correct answer)
• (C) 99285-25, 99291
• (D) 99291