# Critical CARE



## jhofherr (Mar 26, 2008)

I have a Critical care ?

A pt with Pnemonia, plural effusions, lung Ca goes into repisrtory distress and a vent was placed.  The pt's condition was discussed with the family and it was agreed to have a DNR meaning no CPR but for the pt to remain on the vent.  The pt remained on the vent for 5 days and was starting to improve so it was then decided to take the pt off the vent and to be placed on a BIPAP.  During this time she started to decline again and after 4 more days the family decided to remove all measures of critical care and the pt was removed from the BIPAP and almost immediantly passed away.  My ? is can CC be charged with proper documentation to support CC even thought the pt had orders for NO CPR only.


----------



## rthames052006 (Mar 26, 2008)

juleary said:


> I have a Critical care ?
> 
> A pt with Pnemonia, plural effusions, lung Ca goes into repisrtory distress and a vent was placed.  The pt's condition was discussed with the family and it was agreed to have a DNR meaning no CPR but for the pt to remain on the vent.  The pt remained on the vent for 5 days and was starting to improve so it was then decided to take the pt off the vent and to be placed on a BIPAP.  During this time she started to decline again and after 4 moer days the family decided to remove all measures of critical care and the pt was removed from the BIPAP and almost immediantly passed away.  My ? is can CC be charged with proper documentation to support CC even thought the pt had orders for NO CPR only.



Yes, you can bill for critical care in this case just make sure that the physician has documented all that you have stated and the  TIME...being that CC is a time based code FOR 99291 time requirement is 30-74 minutes 99292 is an add on code for each additional 30 minutes.

Of note, if the total time spent in critical care is LESS THAN 30 you would not bill the critical care codes in this case.

Refer to the cpt book for indepth info.

Hope this helps,


----------



## jhofherr (Mar 26, 2008)

The time was there; all other cc measures were there.  We just went round and round on this due to the DNR.


----------



## rthames052006 (Mar 26, 2008)

juleary said:


> The time was there; all other cc measures were there.  We just went round and round on this due to the DNR.



No problem, the DNR really doesn't have a bearing on billing the CC.


----------



## vjst222 (Mar 27, 2008)

I totally agree, as long as the time is documented the DNR doesn't matter. The Dr still spent his/her time there regardless of the DNR.


----------

