Wiki Critical care time

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alices

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Does the DR have to specifically state Critical Care Time for me to give it? I have a pulmonologist that said " I spent 40 minutes in ICU exclusivley with this pt" the billing service is claiming critical care because of that statement..if he does have to state critical care is there any resource/documentation I can get to show him..thank you..alice
 
kgoldman

Yes, the provider has to state Critical Care Time and how long it was provided. Just because they are in ICU does not necessarily mean it is critical.
 
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I hope this helps.
CPT definition of the Critical Care:
99291:Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
99292:Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service).
Section Notes - 99291-99292 Critical Care Visits: Patients 72 Months of Age and Older - (99291-99292)

Being the 3rd party. Whenever I review supporting documentation to allow or deny. I always make sure all the key components like for all other E/M codes/services are met. In addition, I also look to see if the 'time/minutes' have been noted. If any of the key information is missing I dney the setvice.

Fran Muldoon LPN CPC
Providence R.I. Chapter President.
 
Please review the Critical Care Services guidelines in CPT. The time must be documented but it MUST meet critical care guidelines above all. I don't have anything solid in front of me but the many training sessions I have done state it doesn't have to say "40 minutes of critical care" you just need to be sure 1) it meets critical care guidelines, 2) time is documented, 3) time documented does not include time for services provided that can be billed separately.

Hope that helps.
 
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