Essential Steps For Mastering Critical Care

“CPT currently defines a critical illness or injury as an illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition.” -ACEP.Org.

The need for a deeper understanding of critical care cannot be underestimated. While physicians should not be overreaching in their coding, they certainly should not be undervaluing their services, either. Coders need to be as informed as possible for the sake of their practice.

Tune into our free webinar, "Providers And Critical Care: A (Potentially Dangerous) Love Story," to dive deeper into critical care, E/M services, documentation and more:

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Examples of Critical Care Services

  • Renal Failure
  • Hepatic Failure
  • Metabolic Failure
  • Respiratory Failure
  • Circulatory Failure
  • Post-Operative Complications

Critical Care Documentation Requirements Checklist

  • The critical and unstable nature of the patient’s condition should be accurately documented to support the medical necessity of the extended 1 to 1 services
  • Complexity of medical decision making
  • Aggregation of time spent by the billing provider if applicable
  • Procedure(s) time(s)
  • Patient assessment
  • Family discussions – substance of discussion
  • Total time spent – Key Component
  • It is important to note that the documentation must match the complexity of medical decision making as well as the time spent in critical care exclusive of time spent during invasive diagnostic or therapeutic procedures such as intubation, bronchoscopy, cardioversion, tube thoracostomy, or central venous catheter insertion.

Documentation Failures-Watch Out For These Common Mistakes

  • Documentation doesn’t support the level of services of Critical Care
  • Signatures: Lacking, illegible, and invalid. These are most notable when the medical record is in the electronic format
  • No medical necessity
  • Missing or insufficient documentation
  • Total amount of critical care time not documented in the patient’s medical record for each date of service

Important Reminders

  • NO split shared services allowed
  • Reflective of the care by a single provider
  • Only one provider can bill for any single time period
  • Documentation of focused time spent on the patient.
  • Can be continuous or intermittent and aggregate time increments over a given calendar date
  • Must meet time minute requirements
  • Critical care is based on patient condition, not patient location

Understanding critical care is paramount for the financial and compliance success of your organization. Physicians must strike a balance between overreaching in their coding and undervaluing their services. Coders need to be as informed as possible for the sake of their practice.

Questions or Comments?