Results 1 to 3 of 3

Critical Care requirements for Neurologists

  1. #1
    Location
    Baton Rouge
    Posts
    1,241
    Default Critical Care requirements for Neurologists
    New Call-to-action
    My neurologists that see patients at a nearby hospital (usually being consulted on ER cases) have a question about requirements for billing Critical Care (99291-99292). I've given them the guidelines from the current CPT book that state that "providing medical care to a critically ill, or injured, or post-operative patient qualifies as a critical care service only if both the illness or injury AND the treatment being provided meet the above requirements". They are arguing that at times, the patient's illness meets the critical guidelines, but no treatment is given. Based on the book guidelines, this would not meet the CC guidelines, but they feel that the intensity of the service/severity of the patient's condition should still meet the guidelines. Some examples are if the patient is in status epilepticus, myasthenia gravis crisis, hypoxic brain injury due to cardiac arrest, encephalitis. The most common example of when they do meet the CC guidelines is stroke patients who have TPA ordered. Can anyone give any insight or documentation that would agree with their opinion that these patients qualify for CC codes even though they don't meet the book guidelines?

    TIA!!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  2. #2
    Default
    Maybe I'm not completely understanding your physicians' opinion, but it seems to me you're asking a bit of a circular question of how the code description could be met by some means other than by meeting the description given for that code.

    I think CPT is pretty clear that the treatment referred to 'involves high complexity decision making to assess, manipulate and support vital system function(s)' and that this is a required component of the service represented by this code. If 'no treatment is given' then there is no treatment 'there' to meet this requirement - how can you manipulate and support vital system functions without administering treatment? Critical care is an intervention to stabilize a patient in order to save their life - if there is no treatment, then what services exactly are the physicians providing that they think should meet these definitions?
    Thomas Field, CPC, CEMC

  3. #3
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by thomas7331 View Post
    Maybe I'm not completely understanding your physicians' opinion, but it seems to me you're asking a bit of a circular question of how the code description could be met by some means other than by meeting the description given for that code.

    I think CPT is pretty clear that the treatment referred to 'involves high complexity decision making to assess, manipulate and support vital system function(s)' and that this is a required component of the service represented by this code. If 'no treatment is given' then there is no treatment 'there' to meet this requirement - how can you manipulate and support vital system functions without administering treatment? Critical care is an intervention to stabilize a patient in order to save their life - if there is no treatment, then what services exactly are the physicians providing that they think should meet these definitions?
    Thank for your reply, Thomas. I completely agree with you - lack of treatment means that they do not meet the guidelines. But I was asked to post the question during a discussion about this at a recent department meeting, so here I am.

    In some cases, no treatment is given because the patient doesn't qualify for it, for example TPA, if the patient is past a certain time window since first symptoms, they do not qualify to receive TPA. I'm not sure of other examples.

    I appreciate your input.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

Similar Threads

  1. Critical Care - Can you bill critical care
    By mcleveland in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 09-29-2015, 04:48 PM
  2. Critical care documentation requirements
    By Mindy Davis in forum Emergency Department
    Replies: 3
    Last Post: 06-23-2015, 07:37 AM
  3. Replies: 7
    Last Post: 01-31-2014, 12:34 PM
  4. Replies: 4
    Last Post: 10-19-2010, 09:37 AM
  5. Critical Care - billing critical care
    By Krecher in forum E/M
    Replies: 2
    Last Post: 05-13-2008, 05:50 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.