Critical Care Nightmare


Best answers
Hello all,

I'm a coder for a general surgery/trauma group who is running into a little problem with one of the surgeons. We are in the process of re-educating the doctors on the proper use of a critical care code (ie not just because the patient is a trauma I activation). This particular doctor is arguing that most of the patients he sees in trauma I "could have" life threatening conditions, so he feels he should be able to code based on that. Does anyone out there know of any articles,newsletters, or documentation that will help explain the critical care coding concept a little better?

Thank you!
Erin Spada,CPC
If you look at the Critical Care guidleines drawn out in the AMA CPT It states it pretty well for you. It does not state that the patient "may" have a critical condition, it states "Critical Care is the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient." There is no mention of a pattient that may be it states that they are. Then it goes on to define what a critical illness is, "A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life treatening detriotation in the patient's condition." And it does go on. I would check it out and start there.