Counseling Code Status Family

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Malone
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Note 1
I have a patient in ICU, the doctor's entire note is subjective and at the end he wrote "Time Spent : 1 hour, 30 minutes greater than 50% of which involved counseling/discussion of code status with family", no examination.

Note 2
The day after the above note, again, subjective only, with note at the end
"Time Spent: 45 minutes grater than 50% involved counseling concerning end of life issues" and a separate discharge summary/death note.

How would I code day one and day 2?
 

1073358

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It depends on if they meet criteria for critical codes. If you feel they do, I would bill 99291 and 99292 for day 1 and for day 2, just bill 99291 again.

If they do not meet criteria for critical care, then I would just use the 99233 code. You could have maybe thought about using the prolonged care code if he had stated his times more specifically. I don't know alot about these codes, but I know there are strict time usages with them.
 
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Milwaukee WI
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Subsequent hospital plus prolonged

It's difficult to tell without seeing the entire note, but I wouldn't use the critical care codes unless the documentation clearly stated that the patient was critically ill and that the care provided is critical care.

I would instead use the appropriate subsequent hospital visit code plus prolonged service. For 99233 you need 35 minutes to meet the level for the code itself. Any time over and beyond that, provided it is at least 30 minutes, may be applicable to prolonged service.

It is my understanding that CMS (or at least some carriers) now require that actual start/stop times be recorded to use these codes.

For day 2 another option is to bill the discharge > 30 minutes 99239.

F Tessa Bartels, CPC, CEMC
 
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