What is critical Care coding ?

Critical Care :

Critical care is the direct delivery of medical care, by a physician(s), for a critically ill or critically injured patient. CMS defines critically ill and injured patients as those who are experiencing one or more vital organ failure(s) and who have a high probability of life-threatening deterioration in their condition. Critical care requires high complexity medical decision-making to assess, manipulate and support vital organ system function in order to treat single or multiple vital organ system failure.

Critical care may be provided on multiple days, even if no changes are made in the treatment rendered to the patient, provided that the patient’s condition remains critical.

Critical care DOES NOT need to be provided solely in an intensive care unit.  Critical care and other E/M services may be provided on the same day by the same physician.Know more At Medical Coding Training

 
  The following services are INCLUDED in critical care and should not be reported separately:

1)      Cardiac output measurements

2)      Chest X-ray interpretation

3)      Pulse oximetry

4)      ABGs

5)      EKG interpretation

6)      Gastric intubation

7)      Transcutaneous pacing

8)      Ventilator management

9)      Peripheral venous access

     10)  Arterial puncture  

The Key Elements of Critical Care:

 

1)99291

 

2)99292

 

99291: This Code is Used for Critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes. It is to be reported only once per day per physician or group member of the same specialty.

99292: Critical care, evaluation, and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service). This code is used ONLY in conjunction with the 99291 code.  EACH additional thirty minutes beyond the first hour of critical care is reported using this code.  For example, if you spend 90 minutes on critical care in one calendar date, the encounter would be reported by using the 99291 for the first hour, plus one 99292 code used to report the additional 30 minutes.

Critica care settings :

Large medical facilities usually have intensive care units (ICU), where critical patients receive care. Some facilities have multiple units depending on the circumstances and needs of the community. ICUs might be located near the operating rooms for critical postoperative patients, or near the telemetry floor for patients who have life-threatening cardiac issues (e.g., cardiac care units).

Services included in critical care codes :

The following services are included in critical care codes, so coders should not report them separately:

§  The interpretation of cardiac output measurements

§  The interpretation of chest x-rays

§  Noninvasive ear or pulse oximetry for oxygen saturation 

§  Analysis of clinical data, stored in computers (e.g., electrocardiograms, blood pressures, hematologic data)

§  Gastric intubations, requiring a physician’s skill as well as fluoroscopy, image documentation and report

§  Temporary transcutaneous pacing (i.e., a temporary method of keeping the patient's heart beating by delivering small jolts of electricity to the heart)

§  Ventilatory management for patients who have been placed on ventilators to assist with breathing

§  Vascular access procedures for the purpose of drawing blood samples

 Time-based codes: 

Report critical care based on the time spent providing care. There are two codes used for critical care:

§  CPT code 99291: Critical care, evaluation, and management of the critically ill or critically injured patient; first 30–74 minutes.

§  CPT code +99292: Critical care, evaluation, and management of the critically ill or critically injured patient; each additional 30 minutes. (List separately in addition to primary service.)

Report code +99292 more than one time if the physician spends more than 30 

additional minutes. For example, consider the following:

§  For 75–104 minutes: Use 99291 X 1 and 99292 X 1

§  For 105–134 minutes: Use 99291 X 1 and 99292 X 2

§  For 135–164 minutes: Use 99291 X 1 and 99292 X 3

§  For 165–194 minutes: Use 99291 X 1 and 99292 X 4

The critical care codes coders assign should reflect the total time spent for each 24-hour period the physician provided critical care. The time does not have to be continuous.Get More Info at; Medical Coding Training Hyderabad