3 Things Auditors Need to Know About Critical Care Codes

Auditing for critical care is confusing and takes some serious detective skills. Sherlock anyone? It requires you to carefully comb a physician’s notes in search of keywords that indicate whether or not the physician was justified in coding for critical care. And, for extra fun, there are some gray areas in critical care that can make it difficult for even the most experienced auditors to decipher. Seriously, sometimes it can feel like you need to call Indiana Jones.

When it comes to auditing for critical care there are three things you need to remember to improve accuracy and be the auditing boss you’ve always wanted to be:

1. Critical care codes are coded by time. Tick, tock. This is the most commonly missed factor when auditors review these services.
2. Just because the patient is critically ill does not mean the visit can be billed as critical care. In order to code critical care, the physician must be doing a life-saving measure during that specific visit. Not actively saving a life? Say no to critical care.
3. There must have been complex Medical Decision Making during the visit. No complex Medical Decision Making? Then say no to critical care.
   

   "In fact, just shout, 'No,' at your audit. It’s cathartic and your co-workers will be like, 'Wow, that’s passion.'"
   
   

Join our upcoming webinar, To Code or Not to Code: Understanding Critical Care, to learn how to decipher a physician's Medical Decision Making to determine whether to report the patient as either high level E/M services or critical care. We'll help clarify this sometimes foggy picture by providing tips and trick to ensure your audits are always fly and on point.