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Pediatric Critical Care - condition of the patient

  1. #1
    Cool Pediatric Critical Care - condition of the patient
    Medical Coding Books

    I have verified the place of service and childs age to use 99291-99292 or 99293-99294..
    'I have received records to review, on the records I will have an initial time of 10:00 a.m., doctors orders, then same date of service later I'll have another note with a Dr. note 11:30 a.m. no end time, then another note 2:00 p.m. to 4:00 p.m.

    I know that the notesx have to reflect the condition of the patient to fall under "critical care guidelines", but how does one add up times if each individual note does not include start and end time?

    Marilyn CPC, CPC-H, CEMC

  2. #2
    Default You can't
    Part of the requirement for billing critical care is having the time justified. There has to be a start and end time in order to appropriately use these codes. I would educate the physicians on the importance of time in these cases.

    Hope that helps

  3. #3
    Milwaukee WI
    Default 99293-94 deleted
    ALL critical care codes require a statement of the patient's critical condition, AND the nature of the critical care provided. (Just because a patient is critically ill, doesn't mean that THIS physician is providing critical care ... example, critically ill patient has a rash which dermatologist is managing. The dermatologist does NOT code critical care.)

    Now ... The pediatric critical care codes have been completely revised for 2009. See 99468 thru 99480 for patients younger than age 6.

    These new codes are ALL one time per day and cover a 24-hours period.

    For Critical care services provided to children 6 years of age and older you should be using the "adult" codes - 99291-99292. Time (30 minutes or more) MUST be documented. This must be time spent providing direct fact-to-face critical care services (includes floor/unit time for the hospitalized patient), exclusive of any procedures which may be separately coded (e.g. intubation 31500 or CVL placement 36555).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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