TTcpc
Guru
Hello,
I need some assistance because I am caught in the middle of a dilemma between an MD and a coder. I have the MD (palliative care physician) submitting a charge for critical care 99291 for terminal extubation of a patient and the coder wanting to change the code due to the MD not doing care to sustain life per CMS definition: "Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single, or multiple, vital organ system failure;and/or to prevent further life threatening deterioration of the patient?s condition.".
The MD is going on guidance via the pulmonary care society as well as the hospice and palliatve care society that because they are at the bedside monitoring the patient for any issues that should arise due to the extubation such as respiratory distress that they are providing critical care. Unfortunately, I can see both sides, but am in search of guidance that can help me defend either side against the other.
In the note the MD states(there is more to the note, but this is the basis for the CC billing:
IMPRESSION:
88 year old man s/p choking episode with witnessed PEA arrest, now anoxic encephalopathy family electing compassionate extubation.
RECOMMENDATIONS:
1. Discontinue Antibiotics, all non-essential meds, minimize IV Fluids.
2. Family at beside, with church members and pastor - spiritual needs met. All accepting plan of care.
3. Orders written for compassionate extubation to room air despite known respiratory failure anticipate death
Robinul 0.4mg Robinul X 1 now and Q4h prn
morphine 2mg IV Q10 minutes
Versed 2 mg Iv Q15 minutes prn
Personally present for extubation with RN and RT - 2mg IV Morphine given 4 mg total Versed given patient appears peaceful snoring, family at bedside through out the procedure. Updated on Prognosis. Will observe and consider transfer out of ICU later today depending upon status.
Critical Care time 60 minutes
I need some assistance because I am caught in the middle of a dilemma between an MD and a coder. I have the MD (palliative care physician) submitting a charge for critical care 99291 for terminal extubation of a patient and the coder wanting to change the code due to the MD not doing care to sustain life per CMS definition: "Critical care involves high complexity decision making to assess, manipulate, and support vital system functions to treat single, or multiple, vital organ system failure;and/or to prevent further life threatening deterioration of the patient?s condition.".
The MD is going on guidance via the pulmonary care society as well as the hospice and palliatve care society that because they are at the bedside monitoring the patient for any issues that should arise due to the extubation such as respiratory distress that they are providing critical care. Unfortunately, I can see both sides, but am in search of guidance that can help me defend either side against the other.
In the note the MD states(there is more to the note, but this is the basis for the CC billing:
IMPRESSION:
88 year old man s/p choking episode with witnessed PEA arrest, now anoxic encephalopathy family electing compassionate extubation.
RECOMMENDATIONS:
1. Discontinue Antibiotics, all non-essential meds, minimize IV Fluids.
2. Family at beside, with church members and pastor - spiritual needs met. All accepting plan of care.
3. Orders written for compassionate extubation to room air despite known respiratory failure anticipate death
Robinul 0.4mg Robinul X 1 now and Q4h prn
morphine 2mg IV Q10 minutes
Versed 2 mg Iv Q15 minutes prn
Personally present for extubation with RN and RT - 2mg IV Morphine given 4 mg total Versed given patient appears peaceful snoring, family at bedside through out the procedure. Updated on Prognosis. Will observe and consider transfer out of ICU later today depending upon status.
Critical Care time 60 minutes