# Stroke Protocol-Critical Care or Not?



## dentfam (Apr 30, 2009)

My understanding of critical care is that patients need to be critically ill and/or injured impairing one or more vital organ systems.
So, if a patient comes in with possible stroke symptoms with no apparent distress and the doctor is claiming critical care, it doesn't appear that way to me.

Patient's BP was slightly elevated but not critical, no respiratory distress

76yr old female who over the last 24hrs has what sounds like a recurrent TIA with right-sided paresis primarily involving the rt lower extremity.  She has had perhaps as many as 3-4 episodes and as few as 2 over the last 24hrs.  At present time she shows no motor weakness and is complaining of some numbness but has intact sensation.  There is also a questionable history of seizure activity involving the lower extremity. Arrangements have been made for transfer this morning.  While here the patient rec'd aspirin 81mg, Lipitor 80mg and IV normal saline at a keep open rate.  We will allow permissive hypertension as long as her BP does not exceed systolic of 200.

What do you guys think?


----------



## renifejn (Apr 30, 2009)

There is no time listed, so definitely can't be CC


----------



## mkmonahan46 (Apr 30, 2009)

*patient not critical................*

Patient is in observation status, E and M unless doctor is constantly present. See critical care services CPT page 18.


----------



## dentfam (Apr 30, 2009)

*Critical Care?*

Other than the time...I forgot to state that part.  2hrs was listed.
The patient was in the emergency department.


----------



## dentfam (Apr 30, 2009)

*Critical?*



dentfam said:


> Other than the time...I forgot to state that part.  2hrs was listed.
> The patient was in the emergency department.



Also, that was only part of the note.


----------



## Karolina (Apr 30, 2009)

In order to qualify for critical care, the patient must be in a severe condition.
To quote the CPT book: "... there is a high probability of imminent or life-threatening deterioration in the patient's condition. ..." Pages 18 and 19 of the CPT 2009 book contain the detailed description. 
From your quote it doesn't appear as though the requirements for critical care are met. Also, without mention of time you cannot bill critical care, as renifejn already pointed out.
Critical care is really where the patient has the physician's undivided attention for the time documented as such.


----------



## dentfam (Apr 30, 2009)

*Critical?*



Karolina said:


> In order to qualify for critical care, the patient must be in a severe condition.
> To quote the CPT book: "... there is a high probability of imminent or life-threatening deterioration in the patient's condition. ..." Pages 18 and 19 of the CPT 2009 book contain the detailed description.
> From your quote it doesn't appear as though the requirements for critical care are met. Also, without mention of time you cannot bill critical care, as renifejn already pointed out.
> Critical care is really where the patient has the physician's undivided attention for the time documented as such.



Thanks...I forgot to add that the physician did claim 2hrs of CC time, but I do not see the patient qualifying as per your above definition and that's why I was asking for extra opinions.


----------

