Wiki Critical Care Coding - Trauma Service

Create Wiki
A

annaree529

New
Messages
3
Best answers
0
I am in a debate with the Trauma Service Director over the definition of "Critical Care" and what services actually warrent the usage of the "Critical Care" codes. In the definition there is a phase "threat of imminent deterioration at the time of physician visit" the providers are using this interputation as everyone is critical care and every patient that is seen in their service will be billed the critical care codes because of the time spent and the critical care work-up provided. Even if after all the testing comes back and the patient is by no means critical the providers are still billing it as critical care due to the time/service spent. Best way to describe is eveyone is critical care until proven otherwise no matter what the injury/illness is.
Example: pt reports to ED by private vehicle for pain in chest area due to a car fell on top of him (jack broke) all vitial are within normal limits, CT order, Chest Xray ordered ROS all negative Exam all normal contusion on chest...Ct unremarkable; Chest Xray unremarkable patient discharged home with motrin/tylenol prn for pain... Physician billed 35 minutes Critical Care! Argued that the "imminent" risk warranted the critical care work-up.
With all my knowledge and expreience in coding Critial Care I am at a difference of opinion as to what the definition states.
 
I am having an issue with this as well, but from the other coin. The physician feels that there is hardly ever a need to bill critical care on multiple days because the idea is to stabilize the patient. In my example, patient in cardiogenic shock, vasopressors given bp dropping patient tachycardic -- provider spends 2 hours with patient stabilizing vitals putting in an IABP. Patient in the end stabilized, critical care coded.
Because he stabilized patient, he and I are both confused then as to why other providers will code critical care the next days even though patient is stabilized. The wording does state also that "provded the the patient's condition continues to require the level of attention desribed"
I am interested in other's views on this topic....

thanks,
Louise CPC
 
critical care

Critical care is the direct one to one care for a critically injured pt or a critical illness. It involves HIGH complex decision making in order to prevent further life threatening deterioration. As soon as the pt is stable critical care clock stops.
 
Critical Care

I am coding the facility side and we utilize a computer assisted program that give the nursing department prompts for critical care even when the physician doesn't state critical care was ever given. The company states that the physician doesn't have to state critical care and the facility can pick it up when certain types of medications are utilized in the ed setting. Has anyone ever heard of this? I was taught that the physician is the only entity that can state critical care was given. Any thoughts?
 
This is also in the CPT Book...


Use of Critical Care Codes (CPT codes 99291-99292)
Critical care is defined as a physician’s (or physicians’) direct delivery of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.
Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single, or multiple, vital organ system failure;


MLN Matters Number: MM5993 Related Change Request Number: 5993
and/or to prevent further life threatening deterioration of the patient’s condition. Examples of vital organ system failure include (but are not limited to):
•Central nervous system failure;
•Circulatory failure;
•Shock;
•Renal, hepatic, metabolic, and/or respiratory failure.
Although it typically requires interpretation of multiple physiologic parameters and/or application of advanced technology(s), critical care may be provided in life threatening situations when these elements are not present.



Hope this helps, I have billed CC Usually when there is Organ Failure. The Docs would have to really specifiy what is really critical about each encounter. That example you just posted does not Qualify. Unless the patient had Respiratory Failure and needed to be intubated. Then i could See 99291 being billed. These Codes reimburse very high also
 
Last edited:
You must log in or register to reply here.
Top