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Cath Termed and Critical Care?

  1. #1
    Reading, PA
    Default Cath Termed and Critical Care?
    Medical Coding Books
    Patient was having a cath done in an outpt setting and during the procedure the patient became hypotensive and crashed. Patient was given epinehrine and had chest compressoins for over an hour and critical care time was noted. Can we still bill for the cath with a 53 mod and then do we still bill for chest compressions or just critical care?

  2. #2
    Milwaukee WI
    Default Critical Care and MAYBE CPR
    Be prepared to get a denial, or at least a request for documentation.

    Assuming your documentation is all in order, you should be able to bill for:
    cath w/ mod 53
    Critical Care

    Here's the difficult part ... In order to code BOTH CPR and critical care ...(assuming both were done by same person) ... You CANNOT use the time spent in CPR as part of critical care time.

    So your documentation needs to have at least 30 minutes of critical care time that does not coincide with the CPR, if you code both.

    When this was the case, I instructed my doctors to document: X minutes (has to be 30 min or more) spent in direct critical care of this patient, over and above CPR.

    If you DON'T have at least 30 minutes of critical care time over and above CPR, then I'd code one or the other (for our commercial carriers I'd code the critical care; for Medicaid I'd code CPR - I work in pediatrics, so we aren't usually dealing with Medicare).

    Don't forget your -25 modifier on the 99291 if you use it.

    Oh ... and how did the patient do?

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 10-31-2008 at 04:40 PM.

  3. #3
    Reading, PA
    Thanks for your help - I found a very good resource on CMS website that also stated this situation in detail

    unfortunately the patient expired

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