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E/M question by Pulm/Crit Care doc

  1. #1
    Location
    Garden State Chapter, Cherry Hill, NJ
    Posts
    23
    Default E/M question by Pulm/Crit Care doc
    Medical Coding Books
    This question was posed to me by a Pulmonary/Critical Care doc who sees patients in the ICU, most of whom are on a vent... Let me know your thoughts...
    Thanks!

    "If I look at ventilator waveforms and graphics that are displayed, but NOT printed, when rounding on a patient does that count under the [Independent Visualization] “Review Tracings” area for a data point?"

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Not diagnostic
    Well ... vent info is certainly being used by your doctor to make decisions re the appropriate vent settings ... but is he basing his decision solely on this "snapshot" view when he's in the room, or on the culmination of info recorded by nursing staff, residents, etc in the interval since the last visit?

    I'm inclined to say no to his specific question.

    But I'm also thinking that he doesn't need the data points. He probably has enough points with problem and risk to qualify for the level he's thinking of.

    And if he's providing Critical Care, he doesn't need to worry about the data points at all ... just whether the patient is critically ill and he's providing direct critical care of 30 minutes or more.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC.

  3. #3
    Location
    Garden State Chapter, Cherry Hill, NJ
    Posts
    23
    Default
    Thanks for the reply! These are not critical care patients, so he is using the H/E/M for a subsequent hospital care level... There are a few instances where the patient may be Moderate on the Table of Risk, but have 4 problem points and possibly 4 data points (if this "image of a tracing review" can be counted). For these patients, who have a detailed exam documented, it will change the level of service from a 99232 to a 99233. I will post it to our local Medicare A/B MAC and see what they say... Thanks again for your thoughts!

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Moderate risk?
    I would say a patient on a ventilator is definitely in the HIGH risk category: "Acute or chronic illnesses ... that may post a threat to life ... severe respiratory distress ..." Can't get much more severe than needing a ventilator to breathe.

    Our Pulmonologists and Intensive Care docs sometimes lose sight of the fact that what is "normal" for their patient population would cause a family practioner or pediatrician to hyperventilate if they had to deal with it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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