Wiki Critical Care Time

[krwheato]

The neurologist that I code for provides consultations for strokes, seizures, and many other high-risk diagnoses. My issue is, that doctor feels the diagnosis is the driving factor in critical care time. I have explained that critical care time is based upon the time spent in coordination of care excluding procedures. That the reason must be life threatening, and that the care provided is documented. A lot of these patients are seen in the ED, and the neurologist is providing consultation. Some are admitted to ICU by the doctor. I have also explained that the place of service does not determine the critical care status either.

Each case is so different, that I cannot provide an explanation to the doctor as to what may or may not be considered critical care. The doctor feels as if each stroke patient that comes in may be critical care. Sometimes the patient is given a tPa in the ED, or was rushed to have a thrombectomy performed prior to the doctor seeing the patient. To me, if the doctor is not providing services on that day to prevent the threat than it is not critical care. If the patient is status post coiling day 13, is it really critical care? If the patient is status post thrombectomy, and some labs were drawn, is it really critical care?

I think my issue is that I do not know if the work that is being done is considered high risk MDM other than my risk table. I also believe that the doctor has a lack of documentation. The doctor may have performed more care that is not documented.

Does anyone code critical care often, or code critical care for a neurologist? I would appreciate any help! I have checked the E/M University, Medicare website, Neuro sites, and my local MAC.

Thank you!

 

[amsmith]

There may be times when the physician is truly providing critical care services and he should be able to bill as such, but it also sounds like your provider is not routinely providing that critical in the moment care required to bill CC. Keep in mind the requirements to bill CC are 1. the patient was critically ill (based on guideline) during the visit 2. Was greater than 30 minutes (specific amount of time) was spent providing CC services? 3. What made the patient critically ill? 4. What he is doing to treat the patient? The care cannot be duplicated by another physician. My suggestion to you would be to give the physician the description of what CC entails (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 care) and ask him blatantly, would he go into a court of law to defend this based solely on his documentation should CMS hand him a redacted note? If the patient is on another service and they are also providing CC services it is crucial for both services to document start and stop times. I bill CC daily and I also work in a multi-specialty group where specialists outside of CC docs bill CC. I hope this is not information overload.

 

[AmandaBriggs]

I like to counsel my providers that if they have time to stop and get a cup of coffee prior to seeing the patient, then it is likely not critical care. Critical care is just that, care delivered to a critically ill patient that may not survive without that care. If it is just a complex patient that is still unstable, I typically recommend a level 3 hospital follow up visit (ensuring that documentation supports this level of service) if the requirements for critical care are not met.

 

[Lyta2000]

Exactly. Show them the definition of the code. If their documentation supports the code- what system is in organ failure, where is the critical risk? Then fine, otherwise it isn’t critical care.