Wiki Critical Care and Acute Renal Failure Dx

[JDM1228]

I have a physician who feels it is appropriate to bill a critical care visit if the patient has a diagnosis of acute renal failure. Her rationale is that this is a critically illness that acutely impairs one or more vital organ systems (part of the definition in the CPT book). I don't agree because I feel that not every patient who has a diagnosis of acute renal failure is a critical patient. Just wanted to get some other people's thoughts on this.
Thanks

 

[LLovett]

Critical care is not dx driven.

http://www.wpsmedicare.com/part_b/policy/phys022.pdf

I disagree with your providers statement. He could provide critical care in that situation but it must be supported by documentation. Just having a patient with a certain dx does not automatically qualify him to bill anything at all, least of all critical care.

Laura, CPC, CEMC

 

[cleanclaims]

Medicare's NCD

http://www.wpsic.com/medicare/part_b/policy/phys022.pdf

Here is Medicare's National Coverage Determination on this. I think this document says it all, your doc is incorrect, and like the previous posting, DX is not the deciding factor in CPT.

 

[FTessaBartels]

Dermatologist in the ICU

In order to bill critical care codes you must have TWO situations -
1) the patient must be critically ill
2) the physician must be providing critical care (at least 30 minutes direct fact-to-face/unit time)

Acute renal failure would probably meet the definition of a critically ill patient. And the patient does NOT need to be in the ICU to meet this definition.

But if a dermatologist is also following the patient for a rash, even if s/he spends an hour doing so, the dermatologist is not providing critical care ...

Hope that helps.

F Tessa Bartels, CPC, CEMC