Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Critical care

Annie Posted Mon 17th of April, 2017 10:43:53 AM
Provider states he spent 38 mins with on initial visit. The patient was admitted to ICU with abdominal pain and nausea and vomiting. He has blood in his emesis and FOBT positive. He was diagnosised with acute GI with hematemesis and positive FOBT, acute and chronic renal failure, SIRS criteria with fever and Tachycardia, CML. The doctor wants this coded as critical, but I am not sure if its meets Critical care criteria
SuperCoder Answered Tue 18th of April, 2017 06:25:44 AM

Hi,

 

As per time base coding, if provider documented that he spent 38 min on critically ill or critically injured patient for evaluation, management, and providing the patient's care then Critical care codes can be given. Critical care time should be documented not like time spent 38 mins with on initial visit. For the above scenario meet medical necessity criteria as per critical care coding guidelines but provider documented he spent 38 mins with on initial visit not documented as time spent on critical care. In this case critical care codes are inappropriate. Critical care is a time- based service. Payment for critical care services is not restricted to a fixed number of hours, days, or physicians when such services meet medical necessity; and time counted toward critical care services may be continuous clock time or intermittent in aggregated time increments.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5993.pdf

Related Topics