Inpatient Facility Coding & Compliance Alert

Question: We've heard that the patient code status (DNR, DNI, full code) is one of the items to take into account when deciding whether physician services are considered critical care or not. Is that true? Washington Subscriber Answer: The patient's code status doesn't dictate whether the service can be considered critical care -- that's determined by the care that's given. Remember the CPT® guidelines for critical care: "Critical care is the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient. 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 ..." CPT® includes thorough instructions for reporting critical care services with codes 99221 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed [...]