ED Coding and Reimbursement Alert

No one wants to go to the trouble of filing a claim only to have it rejected, especially one as involved as the  typical critical care claim. Consider these scenarios and ask yourself: Should I report a critical care code in this situation? Compare your responses to those following the scenarios.
 
Scenario 1: The physician documents 53 minutes tending to a critically ill patient, during which time she inserted a chest tube and a central line. In her notes, the physician points out that the chest tube and central line procedures took 17 minutes, with the rest of the time devoted to critical care services.
 
Scenario 2: The physician documents 45 minutes of critical care time, during which she inserted a chest tube and central line. The physician provides no other statements or documentation.
 
Scenario 3: The physician's documentation notes 43 minutes spent with a critically injured patient, during which time she inserted a chest tube and central line. In her notes, the physician reports that the chest tube and central line procedure took 18 minutes, with the rest of the time devoted to critical care services.
 
 
Answer 1: Yes, you can report a critical care code. The physician made it very easy for her coding office, taking care to note that the separately billable services only accounted for 17 minutes of the visit, leaving 36 spent on critical care.
 
Answer 2: Based on the documentation provided, you cannot bill for critical care services along with the chest tube and central line. The doctor provides no documentation to prove that at least 30 minutes were spent administering critical care. In this case, query the physician to clarify the time spent involved in the separate procedures. It may help to develop a consensus with the physician group for cases like this, which then could become part of your compliance plan.
 
Answer 3: No, you cannot report a critical care code. The physician's documentation indicates she only spent 25 minutes providing critical care services represented by the critical care codes.