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Thread: Critical Care and Acute Renal Failure Dx

  1. #1

    Default Critical Care and Acute Renal Failure Dx

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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. #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
    Join Date
    Apr 2007
    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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