Wiki Can you charge Critical Care WITHOUT Time Noted?

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sjasontaylor77

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Probably a stupid question but just wondering. If there is no time mentioned but Critical care is noted, 1) would you just default to a 99291, or can you not code any critical care without the time? 2) Can a provider append their note and add the time after the fact?

I had a hard time trying to find something online about this.

Thanks!
 
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Hi, you definitely need to have the time stated in the note in order to use a crit care code and yes, they can add time after, although I don't know if there is a deadline for that.
 
sjasontaylor77 said:
Probably a stupid question but just wondering. If there is no time mentioned but Critical care is noted, 1) would you just default to a 99291, or can you not code any critical care without the time? 2) Can a provider append their note and add the time after the fact?

I had a hard time trying to find something online about this.

Thanks!
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Hi there, please review the guidelines in the CPT manual. They clearly state that the provider must document time.

Correcting a note might be an option, but the provider will need to follow the carrier's rules or guidelines. Here are the guidelines from Noridian, but check with your own MAC. https://med.noridianmedicare.com/web/jeb/cert-reviews/mr/documentation-guidelines-for-amended-records

Sometimes providers' mistakes are "teachable moments." 🤷‍♂️
 
hello, I am not an expert. we do code critical care and the rule is that 99291 applies to pt who's life is in danger and needs to be stabilized. They are patients with organ failure. Therefore, if your pt is discharged today or will be tomorrow, his health is stable and critical care services are not needed.
 
natashalage said:
hello, I am not an expert. we do code critical care and the rule is that 99291 applies to pt who's life is in danger and needs to be stabilized. They are patients with organ failure. Therefore, if your pt is discharged today or will be tomorrow, his health is stable and critical care services are not needed.
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Thank you for your reply. I'm not sure why this cardiologist would think it's OK to code critical care on same day patient is discharged. I've made copies of the CPT Manual regarding coding Critical Care and sent it to her, but to no avail.
 
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