Wiki Do these services qualify for Critical Care coding?

[krotroff]

Pt was brought in to the hospital by ambulance in resp failure, my nephrologist consulted and documented a 99221, the exam was detailed not comprehensive. However due to the severity of the pt's condition, intubated and sedated, and documentation that she spent 45 minutes discussing the pt's care with the family can we bill 99291?

 

[FTessaBartels]

3 requirements for Critical Care

There are three requirements for critical care
1) the patient must be critically ill
2) the treatment must be critical care
3) time (at least 30 minutes face-to-face providing direct critical care) must be documented

You do seem to have a critically ill patient - "respiratory failure"

However you stated that the documentation supports only 99221.

I'm wondering whether your NEPHROLOGIST specialist was providing critical care (i.e. treating the respiratory failure). Simply stating "45 minutes spent" is not sufficient; the documentation must specify that the care provided was critical care (usually treating/manageing organ failure or potential organ failure). -OR-

Was the nephrologist providing some other counselling/coordination of care?
If your physician documented something like this:
Total of 45 minutes spent face-to-face, more than 50% of which was in counseling/coordination of care
THEN, the documentation would qualify as 99222 based on time spent in counseling/coordination of care.

HOWEVER ... simply stating "45 minutes spent" is NOT sufficient to meet the guidelines for using counseling/coordination time to choose a level of care.

Hope that helps,

F Tessa Bartels, CPC, CEMC