Primary Care Coding Alert

Remember: CPT considers many services part of the critical care package When deciding whether your family physician provided critical care services, you-ll need to ask questions about patient status to determine whether the services actually represent critical care. If you decide a patient did not receive critical care services, you-ll need to rely on other E/M service codes.

Once you have identified an encounter as critical care, you need to meticulously document the critical care time in order to file a proper claim, and you also need to decide which services are part of the critical care package and which ones are separately reportable. Further, you have to identify any additional E/M services the physician provides.

There's a lot to keep straight when you are reporting critical care. Check out this advice on how you can ethically maximize reimbursement for your critical care claims. Make Sure Patient Is Critically Ill or Injured You-ll first want to find out if the patient has a critical illness or injury -- if the patient is not critically ill or injured, you cannot report critical care services, says Shelley Bellm, CPC, physician relations and coding manager at Colorado Mountain Medical in Edwards.

According to Bellm, patients requiring critical care have acute -impairment of one or more vital organ systems, such that there is risk (i.e., high probability) of imminent or life-threatening deterioration in the patient's condition. Critical care requires high-complexity decision-making to assess and support the vital organ systems- functionality to prevent deterioration in the patient's condition,- she says. If the physician provides services such as these for at least 30 minutes, it could be a critical care encounter.

Conditions that might require critical care include acute myocardial infarction, respiratory arrest, and severe blood loss, Bellm says.

Example: The physician treats a patient in respiratory arrest in a hospital emergency department. The physician performs cardiopulmonary resuscitation for 15 minutes, then monitors the patient's breathing patterns for 45 minutes.

On this claim, you should report the critical care service and the CPR, Bellm says. When filing this claim:

- report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care.

-  report 92950 (Cardiopulmonary resuscitation [e.g.,  in cardiac arrest]) for the CPR.

-  link 799.1 (Respiratory arrest) to 99291 and 92950 to prove medical necessity for both services.
 
When documenting this claim, be sure to note the start and stop times for the CPR and the critical care, so the insurer knows how much critical care time you are coding for on the claim. Also, know what services are included in the critical care package. While CPR is separately reportable on critical care claims, these services are bundled into critical care:

- Interpretation of cardiac output measurements (93561, [...]