Facility charging of Critical Care

penyoung

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Our facility (hospital) is working on documentation and other issues in order to be able to charge for critical care. However there is a difference of opinion on the interpretation of the definition of critical care in the CPT book. The minority opinion is that the critical nature of the patient (impairment of one or more vital organ systems) must be a proven fact by the time the patient is discharged to even be able to consider critical care. The majority opinion is that the impairment can be a possibility. For example, a patient comes in with chest pain and is worked up for possible MI. If he is proven to have an MI and all other critieria are met we could charge for critical care (minority opinion). However if it turns out to be GERD, we could also charge for critical care (majority opinion) because the impairment was a possibility and resources were expended on that basis. I am in the minority group and don't see how the CPT book can be interpreted any other way. But if I'm wrong I need to know. Any help any one can give, either way will be greatly appreciated.
 
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If I have a headache it MIGHT be a brain tumor

Nope ... chest pain that turns out to be GERD does not a critically ill patient make. Any more than the person who just ran a mile is critically ill because s/he is short of breath.

The patient MUST be critically ill ... not just maybe going to possibly potentially be critically ill.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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