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Critical care billing-staus has not changed

  1. Default Critical care billing-staus has not changed
    Medical Coding Books

    I have a doctor that bills critical care when a patient is in ICU. He frequently bills this, even when the patient's staus has not changed. Through reading and research, I do understand that the patient's conditon has to be life threatening, has to have one or more organ failure. I do understand that even if the patient is stable, the patient's condition can still be critical thus constituting a critical care charge. I have read the CC gudelines that have stated all of the above, it also helped me to realize that daily management on a patient that is on chronic ventilator support does not necessarily constitute a CC charge.So the more I am reading I am understanding this more, I am left with a few grey areas with one being, are there any other Dx's other than failure, shock, and injury that will support a CC charge? Some of the examples in the CC guidelines mentioned pneumonia, AAA, seizure related to renal failure, etc. things of that sort. My physcician does not always have a organ failure or shock ( sometimes he would document suspected shock, can that be considered?) or injury documented. here is two for example:

    Quiescent seizure disorder, Pulm HTN, COPD exacerbation, Dysphagia and thrombocytopenia

    Example 2"
    Chest tube in situ and complicated CAP/S/P decortication for empyema

    Also is there a code for ischemic cardiac injury, and does this constitute a critical care charge?

    Can suspected shock, sepsis or any other suspected conditions be considered as CC?

    What about hypoxic induced injury?

    I apologize for all of the questions, But I code over a thousand visits for two critical care intensivist pulmonary doctors in addition to four other doctors.

    So my brain is on overload, ANY INFORMATION WOULD HELP!

  2. #2
    I am in the same boat as you. I sometimes feel as if it should not be a critical care if the patient is remaining in stable condition BUT the patient is ventilator dependent and has pneumonia so it does fit into critical care. I do believe that hypoxia is considered allowable under cc. I do not know about the possible ....would love to hear another opinion. thanks for posting this

  3. #3
    Milwaukee WI
    Default "Stable" is not a medical diagnosis
    Don't be fooled by "stable." As one anesthesiologist pointed out to me ... a person who is in a deep coma and on a ventilator may be "stable" but still critically ill.

    "Suspected" and "possible" aren't usually indications for critical care, unless you have a patient presenting through the ER who is unable to respond and you're not sure yet what your definitive diagnosis is. You might see "suspected shock," "suspected shaken baby syndrome," etc ... because they don't have enough info yet.

    I'd talk to the doctor(s) involved. Emphasize that the documentation MUST give a clear indication that the patient is critically ill and that the physician is providing critical care. Ask the doctor(s) to help educate you about what constitutes a critically ill patient.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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