Presentation on theme: "Prolonged and Critical Care Codes"— Presentation transcript:
1 Prolonged and Critical Care Codes When to bill and what needs to be documented…..
2 Prolonged Care – When? CPT Codes 99354-99357 Used when time of required patient care exceeds normal time guidelines for E/M codes by at least 30 minutes.Cannot bill second code if <15minutes left after billing for first hour or if <15 minutes left beyond the last 30 minute charge.Time DOES NOT have to be continuous.
3 Prolonged Codes-Correct E/M Prolonged care services ARE NOT payable unless they are accompanied by the E/M companion codes.E/M is chosen based on level of exam, then the prolonged code is calculated.Can be used on any level E/M, does not have to be the highest code UNLESS you are billing based on time alone!!!MUST document total time spent with patientDo not be general, “> 1 hr spent with patient”, be specific, “I spent 65 minutes with patient”
4 What Codes to Use and Documentation Can be used with Inpatient/Outpatient, initial/established patients, consults/follow ups.Minutes of ServiceCodeUnder 30Not reported separately30 – 7499354 (OP) or (IP)(OP) or (IP)X 2 (OP) orX 3 (IP)
5 Standard Times for Outpatient Visits: New Patients:Est. Patients:Consults:5 min9921110 min992019921215 min992139924120 min9920225 min9921430 min992039924240 min992159924345 min9920460 min992059924480 min99245
6 Standard Times for IP Visits: Admits:Follow Ups:Consults:15 minutes9923120 minutes9925125 minutes9923230 minutes9922135 minutes9923340 minutes9925250 minutes9922255 minutes9925370 minutes9922380 minutes99254110 minutes99255
7 Critical Care Codes:Definition: Direct delivery of medical care for a critically ill or injured patient.Acutely impairs one or more vital organ systems, high probability of imminent or life threatening deteriorationEncompasses treatment of “vital organ failure” and “prevention of further life threatening deterioration…”i.e) CNS failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure.Patient must be critically ill at time of service but does NOT have to be in ICU.
8 Correctly Using Critical Care Codes Can include all time spent evaluating, providing and managing patient’s care, as long as physician is immediately available to patient.Physician must devote FULL attention to patient and cannot provide services to any other patient during that time.Physician’s of same specialty and group are billed as one provider.Time does not have to be continuous.Does NOT get reported with an E/M code, unless patient was seen earlier in the day and was not critical at that time!!!!
9 Included in Critical Care Codes: These Procedures ARE included:the interpretation of cardiac output measurements (CPT 93561, 93562)pulse oximetry (CPT 94760, 94761, 94762)chest x-rays (CPT 71010, 71015, 71020)blood gasesinformation data stored in computers (CPT 99090)gastric intubation (CPT 43752, 91105)transcutaneous pacing (CPT 92953)ventilator management (CPT 94656, 94657, 94660, 94662)vascular access procedures (CPT 36000, 36410, 36415, 36591, 36600)
10 What is NOT included in codes: CPR – 92950Endotracheal Intubation – 31500Central Line – 36556Cannot include time spent on procedure in calculation for total critical care time.Cannot include time spent teaching or time spent by the resident in absence of TP.
11 Documenting Critical Care Physician may refer to resident’s dictation for specific history, findings, and medical assessmentPhysician documentation MUST include:Time spent providing critical care excluding any time spent on separately reported proceduresStatement that patient was critically ill during the time the patient was seenWhat made the patient critically illNature of the treatment and management provided
12 How to Use Critical Care Codes Time:Codes:Less than 30 minutesE/M code, not critical care30 – 74 minutes9929175 – 104 minutes105 – 134 minutesX 2Now let’s look at some examples!!!!
13 Critical Care Example: Hospitalist A sees the patient on admission, and spends 40 minutes of critical care time with the patient. That evening, hospitalist B from the same group, that is covering, sees the patient for an 35 minutes of critical care. What codes would get billed?A) Each hospitalist would bill for their initial critical care.B) Hospitalist A would bill and hospitalist B would bill for follow-up,C) Hospitalist A would bill and hospitalist B would billAnswer: C