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Critical Care and Acute Renal Failure Dx

  1. #1
    Default Critical Care and Acute Renal Failure Dx
    Medical Coding Books
    I have a physician who feels it is appropriate to bill a critical care visit if the patient has a diagnosis of acute renal failure. Her rationale is that this is a critically illness that acutely impairs one or more vital organ systems (part of the definition in the CPT book). I don't agree because I feel that not every patient who has a diagnosis of acute renal failure is a critical patient. Just wanted to get some other people's thoughts on this.

  2. #2
    Critical care is not dx driven.

    I disagree with your providers statement. He could provide critical care in that situation but it must be supported by documentation. Just having a patient with a certain dx does not automatically qualify him to bill anything at all, least of all critical care.

    Laura, CPC, CEMC

  3. Default Medicare's NCD

    Here is Medicare's National Coverage Determination on this. I think this document says it all, your doc is incorrect, and like the previous posting, DX is not the deciding factor in CPT.

  4. #4
    Milwaukee WI
    Default Dermatologist in the ICU
    In order to bill critical care codes you must have TWO situations -
    1) the patient must be critically ill
    2) the physician must be providing critical care (at least 30 minutes direct fact-to-face/unit time)

    Acute renal failure would probably meet the definition of a critically ill patient. And the patient does NOT need to be in the ICU to meet this definition.

    But if a dermatologist is also following the patient for a rash, even if s/he spends an hour doing so, the dermatologist is not providing critical care ...

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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