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Critical Care-Do we ? MD or bill as coded

  1. #1
    Question Critical Care-Do we ? MD or bill as coded
    Medical Coding Books
    I have trouble agreeing with CC for this note. I've been told as long as there is organ failure he does not need to describe in more detail. Can someone give me an opinion on this note please? Recurrent VT -discussed with pt and family the need for cath to rule out active ischemia as a cause of v.t. Managed antiarrythmia (amiodarione) stared beta blocker, arranged cardiac cath and ep eval. Ischemic cardiomyopathy -assessed possible volume overload and began beta blocker. He tells me nothing of the V.T. rate, the next day he was hypotensive...never gave me the bp and billed cc. I feel this is just managing the care. We are a teaching hosp, but his not needs to stand on its own. Iv'e been told I am asking for too much.

    A separate patient note I reviewed I feel good about coding he 60 mins of cc. Briefly -MD called to pts room, in V.T. with heart rate at 150 bpm, the MD goes on and on about the care of the patient including the drugs, pace terminated by pacing through device, patient and finally bpm at 70. Includes drugs, the patients mentation and an exam.

  2. #2
    Milwaukee WI
    Default Critical Care
    For critical care you need BOTH a critically ill patient, AND the provision of critical care. And, yes, the description of the care provided and the condition of the patient have to be complete. This can, in fact, be accomplished in a couple of sentences.

    If I'm reading your post correctly, your physician's note reads:
    Recurrent VT -discussed with pt and family the need for cath to rule out active ischemia as a cause of v.t. Managed antiarrythmia (amiodarione) stared beta blocker, arranged cardiac cath and ep eval. Ischemic cardiomyopathy -assessed possible volume overload and began beta blocker.

    (I'm assuming there is time recorded somewhere, or you wouldn't even be considering critical care.) I think your physician needs to improve his description of actions/treatment taken. I see mention of amiodarone, but can't tell whether THIS physician was providing this management effort or whether this is part of the patient's history.

    One more sentence to the effect that this patient is critically ill and at risk for further CV compromise without continuous monitoring, additional drug therapy, and further workup to determine root cause of VT would be enough.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default critical care documentation
    Thanks for your response. Yes, the note did specify the time. Does an auditor look at the documentation other than the date, time and signature to determine if the note/diag and work the MD did supports CC because of the $$? Am I to accept what the MD writes and as long as he has his time, not question anything? I would think like any other level of billing that a coder
    would have to review and make sure the documentation supports the level billed. Are there any sources that can support what you have suggeted?

  4. #4
    Milwaukee WI
    Default What the auditor looks at
    What the auditor looks at depends on the auditor. But if I were the auditor, I would certainly check to be sure that
    1) the patient is critically ill -and-
    2) the care provided was critical care -and-
    3) at least 30 minutes of direct critical care was documented

    I am neither a doctor nor a nurse. If I cannot tell that a patient is critically ill or that the nature of the care provided is critical care, then I'm going to query the physician. Sometimes it's my own lack of knowledge that makes me question. Sometimes it is the physician's less-than-clear documentation.

    I used to work for intensivists. I would sometimes see a note - beautifully detailed - with time noted, but the last sentence would be something like "patient stable for transfer to the floor" ... well, then the patient is no longer critically ill, and it would be more appropriate to code a subsequent hospital visit.

    Conversely I would sometimes see a note where I'd be thinking ... "Criminy, THIS patient is REALLY sick!" But the time would be missing or the doctor had even marked a subsequent hospital visit on the charge ticket.

    In both these types of scenarios I would go back to the physician and ask.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Smile Thank you Tessa
    Your expertise is appreciated. You have confirmed what I do and I will continue to stress as part of correct coding and the standards of a certified coder. I may call on you at some point if I decide to become certified in E&M.

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