Neurosurgery Coding Alert

This audit technique can lead you to extra cash When you see certain phrases in your neurosurgeon's notes, chances are you could be billing for critical care rather than settling for the lower reimbursement of standard E/M codes. "We do so much more critical care than what we bill for. It's unbelievable," Caral Edelberg, CPC, CCS-P, CHC, told attendees at the recent American Academy of Professional Coders conference in Seattle. To collect critical care dollars -- and stay compliant -- physicians and coders must work closely together, says Edelberg, president and CEO of Medical Management Resources in Jacksonville, Fla. Red flag that you-re missing critical care cash: Go back to the records and trace your patients who were later admitted to the intensive care unit (ICU), Edelberg says. If the bulk of those ICU admissions weren't billed as critical care (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes; and +99292, ... each additional 30 minutes [list separately in addition to code for primary service]), you-ve missed the chance to collect those dollars. "Typically, most ED patients requiring admission to the ICU have had critical care in the ED," Edelberg says. The catch: Even if your neurosurgeon provides critical care services to a patient in the ICU, there is a chance that you won't be able to code 99291 or 99292. To use these codes, the neurosurgeon must perform a minimum of 30 minutes of critical care. Otherwise, you may have to code the service with an emergency department E/M code, such as 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity). "I can guarantee you that many critical care cases are not coded properly because of incorrect documentation," Edelberg adds. So coders should educate physicians to provide better documentation about time and content so we can submit those critical care claims. Stable Patients Might Still Need Critical Care To meet the CPT critical care coding criteria, there must be "a high probability of imminent or life-threatening deterioration in the patient's condition involving one or more organ system(s)." Critical care does not require unstable vital signs, Edelberg says. But critical care does "involve high-complexity decision-making to assess, manipulate and support vital system function" as well as "to prevent further life-threatening deterioration of the patient's condition," Edelberg says. Example: The ED admits a man in a coma with severe hypertension. A head CT reveals a thalamic hemorrhage with some intraventricular extension and mild hydrocephalus. The ED physician calls the neurosurgeon to evaluate the patient. The neurosurgeon initiates intravenous medications to control the [...]