# Critical Care Coding - making them stable



## dpumford (Aug 1, 2011)

HELP! If a patient is in ICU and is on a Vent..often due to respritory failure. He is now stable on the vent but not able to be weaned off the vent yet..The hospitalist does docuemnt time etc... for the Critical Care. Would this qualify for critical care

I have had different opinions on this and I know the guidlines but I would like some more insite on this. 

One coder told me that if pt is on a vent; think of it as "if pt was taken off vent they would go in to organ failure and die" The vent is making them stable and if taken off vent they could/would die so Critical care is oppropriate.

Another said, if pt is stable on the vent , he is not IE: crashing,stats are normal etc. The doctor checkings everything and even though the pt is on a vent he is stable on vent so they do not consider this critical care. 

The Vent is making the patient stable, this is where I get confused if this is truely critical care or not??

I would love some more insite on this...I know the guidelines but this ICU billing is new to me and I know there is long term vent care but that is not what this is..Patients are brought into the ICU for being critical/unstable...

SO what I am wondering if being on a vent stable or unstable does this make the guidlines for critical care billing

Any information would be very appreciated!

Thanks so much~


----------



## FTessaBartels (Aug 3, 2011)

*"Stable" is not a medical diagnosis*

I listened to one of the Intensivists on teaching rounds with residents one day. He was telling the residents to stop using the word "stable" .... He said this had no medical meaning. After all a dead person is "stable" - i.e. not changing. 

I tend to ignore that word when I see it.  I look at other documented indications of the patient's condition and medical diagnosis. A person dependent on a ventilator for maintaining respirations is *most likely* critically ill.   (There are patients who are chronically vent dependent ... for example as a result of quadriplegia ... who can go home on a ventilator ... I'm not talking about those patients.)

Talk to the physician and ask him/her to be sure to document WHY the patient continues to need critical care ... respiratory failure, sepsis, etc. Those are codable diagnoses to support the use of 99291-99292.  "Stable" is not a codeable diagnosis.

Hope that helps.

F Tessa Bartels, CPC, CEMC


----------



## dpumford (Aug 4, 2011)

*Critical Care*

Thank you so much for your response F Tessa!  I really appreciate it


----------



## Love Coding! (Aug 4, 2011)

FTessaBartels said:


> I listened to one of the Intensivists on teaching rounds with residents one day. He was telling the residents to stop using the word "stable" .... He said this had no medical meaning. After all a dead person is "stable" - i.e. not changing.
> 
> I tend to ignore that word when I see it.  I look at other documented indications of the patient's condition and medical diagnosis. A person dependent on a ventilator for maintaining respirations is *most likely* critically ill.   (There are patients who are chronically vent dependent ... for example as a result of quadriplegia ... who can go home on a ventilator ... I'm not talking about those patients.)
> 
> ...



Hi Tessa,

Along those lines, my physicians are Nephrologists, we treat renal related issues (ARF, hyperkalemia, etc).  Most of the time the patient is intubated, but that is being followed by the Pulminologist.  My physicians reasoning is, that as a whole, the patient is critically unstable.  But what if we are not the ones following and treating the respiratory condition?

Thanks


----------



## Mojo (Aug 4, 2011)

Patients in the ICU often present a septic picture with multi-organ failure with renal impairment. Acute tubular necrosis causing acute renal failure (now referred as acute kidney injury) and severe electrolyte imbalance are critical illnesses that acutely impair the renal system, a vital organ system. If your nephrologists document extensively the criticality of the patient's renal system, interventions and the required 30 minutes or more time spent fully on the patient, critical care services should be billed. Do not include the time spent inserting a dialysis catheter in the critical care time. The procedure can be reported separately.

Here is an article that may be of interest to you:

http://www.renalmd.org/page.aspx?id=2753&terms=critical+care


----------



## Love Coding! (Dec 8, 2011)

Mojo said:


> Patients in the ICU often present a septic picture with multi-organ failure with renal impairment. Acute tubular necrosis causing acute renal failure (now referred as acute kidney injury) and severe electrolyte imbalance are critical illnesses that acutely impair the renal system, a vital organ system. If your nephrologists document extensively the criticality of the patient's renal system, interventions and the required 30 minutes or more time spent fully on the patient, critical care services should be billed. Do not include the time spent inserting a dialysis catheter in the critical care time. The procedure can be reported separately.
> 
> Here is an article that may be of interest to you:
> 
> http://www.renalmd.org/page.aspx?id=2753&terms=critical+care



Wow! I apologize for not following up on this post, thank you so much for the article! This helps..


----------



## *3boys (Oct 1, 2012)

*vent care in ICU*

From personal experience (my son) I can say that whenever a person is put on a vent there is a possibility they may stay vent dependent, depending on circumstances and length of time that passes. many time folks in ICU stabilize but remain on the vent. During that time there are challenges to the patient with attempts at weaning from the vent by decreasing the rate. There are many patients that breath over the vent as can be observed by watching the vent lights etc. In these cases a patient's body is trying to recover it's own function but not quite there. Also, please remember, most hospitals require patients on a ventilator to be in an ICU type unit as special training is involved for the patient care and monitoring. Because of staff ratios maintained in most ICU type units, patients remain there for care


----------

