Wiki Critcal Care E/M

[member7]

I need to know how auditors are handling documentation coded with critical care codes. The critical care guidelines say you can change to the most appropriate E/M code on the basis of the documentation provided. But if the physician documents the patient is in ICU, but doesn't document the time and/or does not document the intensity of service, what do you do? There's a debate going on in my office. Thanks in advance for any advice.

 

[grahamki]

In order to bill for CC codes, the physician must document the time spent. Time has to be at least 35 minutes. They also must have documentation that supports the time spent. If this is the case then you can code the E&M and the CC code. Hope this helps.

 

[rthames052006]

I need to know how auditors are handling documentation coded with critical care codes. The critical care guidelines say you can change to the most appropriate E/M code on the basis of the documentation provided. But if the physician documents the patient is in ICU, but doesn't document the time and/or does not document the intensity of service, what do you do? There's a debate going on in my office. Thanks in advance for any advice.

In this case since there is not documentation of time or intensity of service I would bill an e/m code and not the critical care since the key element of time is not documented.