Critical care

andersee

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Rose City (Portland, Oregon)
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Does anyone bill critical care for their hem onc docs? If so, what specific conditions (ie pancytopenia) or situations would you consider to be appropriate to bill cc? I would love to talk to anyone who can help educate me in this area.

Thanks much!

andersee@ohsu.edu
503-954-2328
 

kvangoor

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Grand Rapids, MI
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I believe you would bill on the status the hospital has them listed under. If they are listed as CC then you would be able to bill those codes.
 

DeeCPC

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Austin, TX
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I believe you would bill on the status the hospital has them listed under. If they are listed as CC then you would be able to bill those codes.
No, I am sorry but because the hospital lists a patient as critical does NOT make it okay to bill critical care codes. Critical care codes are for a service that is rendered to stabalize a critically ill or critically injured patient. Being in ICU does not justify critical care.

Please read the CPT guidelines for critical care.

Dee
CPC, CPMA, CPCD
 

DeeCPC

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I did audit for hemonc but not inpatient charges so I hesitated to answer. However, I have coded ED so this is what I am thinking:
There are serious reactions to chemo drugs including anaphylaxis. A serious allergic reaction is often coded as critical care because the airway may be compromised requiring intubation to protect the airway.
Chemo weakens the immune system leading to infections –SIRS and Sepsis would be examples of conditions that are coded as critical care because they lead to organ failure and the need for immediate life saving measures.
Repetitive vomiting seen in chemo patients may lead to vomiting blood. If the cause is not immediately known this can be a dangerous situation.
Some hematologic conditions complicate traumas so I would think that a hemophiliac in an accident is treated with a higher level of care than the average person.

None of the conditions are automatically critical care since critical care codes are for a service not a location or a condition...these are just some things to consider.

Dee
CPC, CPMA, CPCD
 
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