Gastroenterology Coding Alert

Take this 2-part quiz to see if time is on your side

No one wants to go to the trouble of filing a claim only to have it rejected, especially one as involved as the typical critical care claim.
 
Consider this pair of scenarios and ask yourself: Can I report a critical care code in this situation? Compare your responses to the answers that follow the scenarios:
 
Scenario 1: The gastroenterologist documents 53 minutes tending to a critically ill patient with severe gastrointestinal bleeding. In her notes, the physician points out that she spent 10 minutes suctioning out blood, 15 minutes discovering the cause of the bleeding and stabilizing the patient, 12 minutes speaking to the patient's wife about his condition, 9 minutes consulting with another gastroenterologist, and 7 minutes discussing treatments with the patient.

Answer 1: Yes, you can report a critical care code. The physician made it very easy for her coding office, taking care to separately list each of the critical care services and how long the doctor spent providing each of them.

Scenario 2: The gastroenterologist reports 45 minutes of critical care time, during which she stabilized a patient who had gone into shock following a routine endoscopy. The gastroenterologist provides no other statements or documentation.

Answer 2: Based on the documentation provided, you cannot code for critical care services along with the routine endoscopy. The gastroenterologist provides no documentation to prove that at least 30 minutes were spent administering critical care.

Best bet: Ask the physician to clarify the time spent involved in the separate procedures. It may help to develop a consensus with the physician group for cases like this, which then could become part of your compliance plan.