Wiki critical care services 99291

[Libby C]

Are there any times that critical care services would be appropriate to code without a patient "crashing" . Can time and counseling, transfer calls and management of an ICU patient ever meet the requirements to use a 99291?
also if anyone has a link that has more explanation than the description of the code I would appreciate it.

thanks in advance

 

[Leandra]

The CMS narrative guidelines have some information regarding critical care. Here is a link: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

 

[thomas7331]

This is an area of great contention with physicians, but in my own opinion and by my reading of the guidelines, the answer is no. As CMS has clarified in the publication (linked below), that the patient must have a "high probability of imminent or life threatening deterioration" AND the services provided must involve "high complexity decision making to assess, manipulate, and support vital system functions to treat single, or multiple, vital organ system failure". A service only qualifies as critical care "if both the illness or injury and the treatment being provided meet the above requirements". In other words, critical care is defined as a complex and urgent intervention. Time spent in activities such as counseling, transferring calls, etc., in and of itself, does not meet this definition. I look for evidence in the documentation that providers had to perform complex and urgent interventions to stabilize and treat the patient. A presenter I once heard speak about suggested using the 'coffee cup test' - in other words, if the physician had time to get a cup of coffee before seeing the patient, then the service automatically should not count as critical care. CMS has also targeted critical care coding for audit in several states and has found very high error rates due to documentation not supporting the definitions of the service.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM5993.pdf

 

[Libby C]

Thanks that is the information and documentation that i needed. The coffee test was perfect for explaining. You guys are great.

 

[carolhodge]

Thomas, your answers are always so helpful and thorough. Thank you for contributing so that others can learn from you. Also, appreciate the links you attach.

 

[ccarey]

Critical care does not have be only in a moment of crisis. CMS further defines as As described in Section A, critical care services encompass both treatment of “vital organ failure” and “prevention of further life threatening deterioration of the patient’s condition.” Therefore, although critical care may be delivered in a moment of crisis or upon being called to the patient’s bedside emergently, this is not a requirement for providing critical care service. The treatment and management of the patient’s
condition, while not necessarily emergent, shall be required, based on the threat of imminent deterioration (i.e., the patient shall be critically ill or injured at the time of the physician’s visit).