Wiki question from doctor about critical care, see below

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kviolet

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For 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)-

Should we be writing new notes and billing for each additional 30 minutes that we are managing our critical care patients who are awaiting an ICU bed. Typically the average length of stay for these patients waiting is about 4-6 hours in our ED before ICU bed is available. I know we are not continuing to document and code for the each additional 30 minutes of care- but I think we should be doing that. Please let me know what the documentation requirements for this are and we will instruct the physicians.

Any input would be great
Thanks!
 
CC Notes

Waiting for a bed in ICU isn't necessarily critical care. So first you have to determine if the medical necessity is still there for CC time. Is the patient still in imminent danger, vitals, interventions etc. 5-7 hours while waiting for a bed is unlikely but not impossible. Having said that, an entirely separate note is not necessary. A continuation indication interventions, meds, patient vitals, re exams etc clearly identifying time spent in CC care is adequate. And remember there are several elements that can be counted toward CC time, but separately billable procedures must be reduced from it.

Jim S.
 
Sources

I think there is a fairly recent CMS IO Letter about CC. Sorry don't have the exact reference with me. Also there are a bunch of articles in the AAPC magazine if you go into the archives. Jim
 
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