# Critical Care and Acute Renal Failure Dx



## JDM1228 (Sep 16, 2009)

I have a physician who feels it is appropriate to bill a critical care visit if the patient has a diagnosis of acute renal failure. Her rationale is that this is a critically illness that acutely impairs one or more vital organ systems (part of the definition in the CPT book). I don't agree because I feel that not every patient who has a diagnosis of acute renal failure is a critical patient. Just wanted to get some other people's thoughts on this.
Thanks


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## LLovett (Sep 16, 2009)

Critical care is not dx driven. 

http://www.wpsmedicare.com/part_b/policy/phys022.pdf

I disagree with your providers statement. He could provide critical care in that situation but it must be supported by documentation. Just having a patient with a certain dx does not automatically qualify him to bill anything at all, least of all critical care.

Laura, CPC, CEMC


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## cleanclaims (Sep 16, 2009)

*Medicare's NCD*

http://www.wpsic.com/medicare/part_b/policy/phys022.pdf

Here is Medicare's National Coverage Determination on this.  I think this document says it all, your doc is incorrect, and like the previous posting, DX is not the deciding factor in CPT.


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## FTessaBartels (Sep 16, 2009)

*Dermatologist in the ICU*

In order to bill critical care codes you must have TWO situations - 
1) the patient must be critically ill
2) the physician must be providing critical care (at least 30 minutes direct fact-to-face/unit time)

Acute renal failure would probably meet the definition of a critically ill patient. And the patient does *NOT *need to be in the ICU to meet this definition.

But if a dermatologist is also following the patient for a rash, even if s/he spends an hour doing so, the dermatologist is *not* providing critical care ...

Hope that helps.

F Tessa Bartels, CPC, CEMC


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