Wiki Critical Care

[heatherwinters]

The clinician I am coding for has a patient who is in ICU for an extended amount of time. Some of the notes he wants to bill critical care for, he states, "patient is relatively stable" or "remains stable". He is managing the overall disease processes in his notes. Do these qualify as critical care if he documents at the end of the note "provided 60 minutes critical level care to patient"?

 

[ARCPC9491]

I wouldn't use critical care, the patient has to be unstable, which clearly he's not. I would use subsequent care codes.

 

[FTessaBartels]

Probably not

Without seeing the entire note, it's hard to tell if the patient is still critically ill and the care provided is still critical care. You say the physician is managing the entire disease process.

A patient could be stable and still critically ill. Patients on a ventilator are frequently "stable" ... i.e. there is no change ... but they are critically ill and requiring a high level of support to maintain life. Or perhaps they require drug therapy necessary for maintaining cardiac or renal function, etc.

Better phrasing would be "critical but stable condition."

One of our critical care attendings used to tell the residents that "stable" really means nothing medically ... to quote that teaching physician "A dead person is stable." He said if they should be able to articulate why a patient requires continued ICU care. We always asked that the first sentence under assessment/plan was a statement that supported continued critical care ... what are the problems that define that a patient is critically ill?

If you can't tell from the note, Heather, as a lay person, that the patient is really sick, then the documentation probably doesn't support critical care codes.

Hope that helps.

F Tessa Bartels, CPC, CEMC