Cardiology Coding Alert

Question: Does discussion time with family members count toward critical care?

Codify Subscriber

Answer: It’s possible for family discussion time to count toward critical care time, but it depends on the situation. Documentation must show the patient was unable to participate in the discussion and that the discussion with family was related directly to patient management.

The rule: CPT® guidelines state, “when the patient is unable or lacks capacity to participate in discussions, time spent on the floor or unit with family members or surrogate decision makers obtaining a medical history, reviewing the patient’s condition or prognosis, or discussing treatment or limitation(s) of treatment may be reported as critical care, provided that the conversation bears directly on the management of the patient.”

Keep in mind: Meeting the requirements for critical care isn’t easy. According to CPT® guidelines, “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 function(s) to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient’s condition.”