Wiki Critical care documentation requirements

[Mindy Davis]

I'm needing clarification on what is required to bill critical care besides time. I know about the time of at least 30 mins is a must in order to bill critical care. But what about the # of ROS or PE's? It's my understand that their isn't a minimum or maxium amout of ROS & PE's to be docuemnted. Those only matter when coding for 99281-99285.

The pt that this is in reference to was clearly critical and critical care time was documented but only 2 PE's were docuemented. So I'm asking would I be able to code the critical care based?

 

[amjo30]

Yes, you can report the critical care time as long as you subtract out the time of separately reported procedures from the total critical care time. You must have at least 30 mins left after subtraction. Also, physician full attention must be to the patient only during the critical care period. This is for physician coding. Facility side have different guidelines. I only code for physician.

 

[Mindy Davis]

Yes I know about the time. I was asking if there had to be so many ROS's and PE's like there has to be bill a 99285. I can't find anything that states there has to be a certain amount of Review of systems or physical exams.

 

[mceisele]

Because it is time-based, there are no requirements for ROS, PFSH, exam, etc; but the CPT book does state that it involves, "high complexity decision making..".

Celeste