Critical care documentation: Difference between revisions

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==Background==
==Background==
*Delivery of critical care is common in the ED setting.
*Multiple components must be satisfied and appropriately documented in the medical record when delivering critical care in the ED.
*Multiple components must be satisfied and appropriately documented in the medical record when delivering critical care in the ED.


===Elements of Critical Care Time===
==Elements of Critical Care Time==
*'''Critical illness or injury''' = illness or injury that impairs one or more "one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”
*'''Critical illness or injury''' = illness or injury that impairs one or more "one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”
*'''Critical care services''' = direct medical care for the patient that involves “high complexity decision making to assess, manipulate, and support vital organ system failure.”
*'''Critical care services''' = direct medical care for the patient that involves “high complexity decision making to assess, manipulate, and support vital organ system failure.”
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*'''Time''' = total time spent evaluating, managing, and providing care to a critically ill patient. Does not have to be continuous. Includes direct patient care at bedside as well as time spent reviewing test results, discussing the case with consultants or family members, and documenting in the patient's chart.  
*'''Time''' = total time spent evaluating, managing, and providing care to a critically ill patient. Does not have to be continuous. Includes direct patient care at bedside as well as time spent reviewing test results, discussing the case with consultants or family members, and documenting in the patient's chart.  


==Critical Care Diagnoses==
===Time Calculation===
The following diagnoses may qualify for documenting critical care time:
*Time spent in critical care activities must exceed 30 minutes in order to bill for critical care time.
*Active Seizures / [[Status Epilepticus]]
**CPT Code 99291 is used for the first 30-74 minutes of critical care time
*Acute [[Altered Mental Status]] / Unconscious
**CPT Code 99292 is used for additional blocks of time of up to 30 minutes beyond the first 74 minutes of critical care time
*[[Gastrointestinal bleeding|Acute GI Bleed]]
*Must document either a specific time or, e.g., "in excess of 30 minutes".
*[[Stroke (main)|Acute Stroke]]
*Calculated time must exclude all separately billable procedures
*[[Anemia]] requiring transfusion
**These include (but are not limited to): central line or transvenous pacemaker placement, chest tube placement, endotracheal intubation, CPR.
*[[Atrial fibrillation with RVR|A fib with RVR]]
*[[ACLS (Main)|Cardiac Arrest]]
*[[Delerium tremens]]
*[[Diabetic ketoacidosis|DKA]]
*[[Ectopic pregnancy]]
*[[Hyperkalemia]] requiring acute intervention
*[[Undifferentiated shock|Hypovolemic shock]]
*[[Hemorrhagic stroke|Intracerebral Hemorrhage]]
*Moderate to Severe [[Asthma]]
*Moderate to Severe [[Congestive heart failure|CHF]]
*[[Toxicology (main)|Overdose requiring reversal agents]]
*[[Pneumothorax]]
*[[Pulmonary embolism]]
*[[Shortness of breath|Respiratory distress]] requiring BiPAP or intubation
*[[Sepsis]]
*[[STEMI]]
*Suicidal ideation with immediate threat
*[[Paroxysmal supraventricular tachycardia|SVT]]
*[[Unstable angina]]


==Sample Documentation==
==Sample Documentation==




Revision as of 22:28, 24 December 2016

Background

  • Delivery of critical care is common in the ED setting.
  • Multiple components must be satisfied and appropriately documented in the medical record when delivering critical care in the ED.

Elements of Critical Care Time

  • Critical illness or injury = illness or injury that impairs one or more "one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”
  • Critical care services = direct medical care for the patient that involves “high complexity decision making to assess, manipulate, and support vital organ system failure.”
    • CMS additionally mandates that for medicare patients, "the failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant or life threatening deterioration in the patient's condition".
  • Time = total time spent evaluating, managing, and providing care to a critically ill patient. Does not have to be continuous. Includes direct patient care at bedside as well as time spent reviewing test results, discussing the case with consultants or family members, and documenting in the patient's chart.

Time Calculation

  • Time spent in critical care activities must exceed 30 minutes in order to bill for critical care time.
    • CPT Code 99291 is used for the first 30-74 minutes of critical care time
    • CPT Code 99292 is used for additional blocks of time of up to 30 minutes beyond the first 74 minutes of critical care time
  • Must document either a specific time or, e.g., "in excess of 30 minutes".
  • Calculated time must exclude all separately billable procedures
    • These include (but are not limited to): central line or transvenous pacemaker placement, chest tube placement, endotracheal intubation, CPR.

Sample Documentation

See Also

External Links

References

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