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Critical care in neurology

  1. Default Critical care in neurology
    Medical Coding Books
    I'm new to neurology coding, and there's a lot more E/M than I'm accustomed to with my General Surgeons. My newest Neurologist is coding a lot of critical care codes for ICU patients. We've explained to him that just because the patient is in ICU doesn't mean he can bill a critical care code, but I'm not actually certain under what circumstances he CAN bill a critical care code.

    His most common diagnoses are stroke, heart attack (with secondary stroke, coma or anoxic brain damage), and brain hemorrhage.

    Is it critical care if he evaluates a patient who is comatose after a heart attack and recommends changes to their prescriptions? What if he doesn't have anything to recommend?

    Can you bill a critical care code one day, and then a subsequent hospital visit, and then another critical care code?

    Any help would be greatly appreciated, thanks!

  2. #2
    Flower City
    Default critical care in neurology
    Neurologists can bill critical care following the critical care guidelines in CPT. The key is following the guidelines for time, the necessity per the severity of the condition the patient is in - is it life threatening or is there a need for the intensity of service to manage the patient even if they are maintaining a status (not decompensating necessarily) You are correct the site of service does not drive the procedure code. Hope that is a bit helpful.
    Marianne Wink, RHIT, CPC, ACS-EM

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