Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition.
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ACEP Now: Vol 35 – No 09 – September 2016The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Critical Care: It’s All About the Timing
Question: I’m a bit confused about the time requirement for critical care services. There are times when I’m at the patient’s bedside for less than 30 minutes, but have been told the time requirements can include more than bedside time. Can you elaborate?
Answer: That’s a great question. You’re correct in that critical care is a time-based code, 99291 for 30–74 minutes and 99292 for each additional 30 minutes. That includes time at the bedside, record review, documentation time, and historical and treatment conversations with EMS, consultants, and the patient’s family (eg, as proxy for the patient).
For the time to count, you should be focused on the care of only that patient and be immediately available to the patient. There are times, however, that the clock is paused; this includes time caring for other patients as well as procedures that are separately billed, such as placing a central line, CPR, intubation, and chest tubes. Teaching physicians should include only the time they personally spent caring for the patient and not time spent by a resident. It’s also best to specify the total amount of time you spent providing critical care (ie, “50 minutes”) rather than using a range such as “30–74 minutes.”
For more information, please check the ACEP reimbursement FAQs at https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Critical-Care-FAQ/.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Adler is assistant medical director of the emergency department at MedStar Montgomery Medical Center and chief coding and reimbursement officer for Emergency Medicine Associates in Olney, Maryland. Dr. Lempert is chief medical officer, health care financial services, at TeamHealth, based in Knoxville, Tennessee.
3 Responses to “Documentation Pearls for Critical Care Services’ Time Requirement”
October 5, 2016
ScottGreat advice! I work in the coding department for a physician practice. Many clinicians don’t realize CC time can also be recorded when not working directly with the patient. It is important for them to capture all CC time whether it be documentation, reviewing records, or direct patient interaction.
October 5, 2016
Bob AbbeyValuable information to know!
October 5, 2016
Dr. SGreat clarification to a question I’ve often wondered about. Thank you