Critical Care- Covid 19

michiboo

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IF an infectious physician does not actually touch the patient due to isolation, but is monitoring the machines and meds, may the physician bill for critical care??


Subjective
Chief Complaint:
SOB


HPI:
Per RN, fevers with chills and sweats, no diarrhea, on vent and proned, on Levophed


Review of Systems
Unable to obtain due to:
Intubated and sedated


Objective
Pulse Ox 96 05/31 0502
B/P 96/56 05/31 0502
FiO2 50 05/31 0502
Pulse 70 05/31 0502
O2 Delivery Ventilator 05/31 0313


Medications:
Active Meds + DC'd Last 24 Hrs
Senna/Docusate Sodium 1 TAB BID 9A 9P PO
Furosemide 40 MG BID IV (DC)
Albumin Human 100 ML ONCE ONE IV (DC)
Insulin Human Lispro 0 Q6HR SUBQ
Senna/Docusate Sodium 1 TAB BID PRN PRN PO (DC)
Cefepime HCl 1,000 MG Q8H IV
Famotidine 20 MG BID NG
Zinc Sulfate 220 MG BID NG
Dexmedetomidine HCl 400 MCG ASDIR IV
Sodium Chloride 96 ML
Sodium Chloride 250 ML ASDIR PRN IV
Heparin Sodium/Dextrose 250 ML ASDIR IV (CKD)
Aspirin 81 MG DAILY NG
Heparin Sodium (Porcine) BOLUS NEEDS FOR PROTOCOL
ASDIR IV
Miscellaneous Information 1 EACH ASDIR IV (CKD)
Acetaminophen 650 MG PRN PRN GTUBE
Midazolam HCl 4 MG Q4H PRN PRN IV
Vasopressin 20 UNITS TITRATE IV (CKD)
Sodium Chloride 100 ML
Fentanyl Citrate 100 ML ASDIR IV (CKD)
Propofol 100 ML ASDIR IV (CKD)
Norepinephrine/Dextrose 250 ML ASDIR IV
Sodium Chloride 10 ML Q12H PRN PRN IV
Pharmacy Consult 1 EACH ASDIR PER TUBE
Dextrose 37.5 GM ASDIR PRN PO (CKD)
Dextrose/Water 12.5 G ASDIR PRN IV
Glucagon 1 MG ASDIR PRN SUBQ

Physical Exam
General appearance:
respiratory support, sedated, no acute distress, no respiratory distress
Physical examination not performed given patient in isolation and limited PPE

Diagnosis, Assessment & Plan
1. Acute hypoxic respiratory failure
2. Pneumonia- confirmed COVID-19 infection
3. Septic shock
4. ARDS
5. Acute kidney injury- status worsening
6. Leukocytosis- new problem


1. Cont vent support and Pulmonary/CC following
2. D/C'd IV Vancomycin given no evidence of MRSA PNA at this time. Cont IV Cefepime for 7 days- end date 6/2
3. If continued fevers and worsening leukocytosis, repeat urine/sputum/blood cultures
4. Cont isolation given COVID-19 infection
5. Cont pressor support if indicated
6. Monitor CBC, CMP, D-dimer, CRP, LDH, and Ferritin daily
7. S/P Tocilizumab on 5/26
8. S/P convalescent plasma on 5/25
9. S/P Remdesivir for 5 days

Updated above recs with RN

I spent 35 minutes of critical care time with the patient of which more than 50% of the face-to-face time was spent on counseling and coordination of care
 
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