tci ED Coding & Reimbursement Alert - 2017 Issue 5

Critical Care Scenarios: Consider These Case Examples That Suggest Either Critical Care or Not

Certain documented phrases suggest the patient encounter qualifies for critical care. A clearly documented critical care time statement helps clue coders into the fact that the physician thinks the encounter qualified for critical care. However, you also need to satisfy the requirement that the patient is critically ill or injured. That can be hard for a coder who is not clinically trained, but if certain phrases appear in the chart documentation, they suggest the high probability of imminent, life-threatening deterioration threshold that CPT® requires, says Rebecca Parker, MD, FACEP, president of Team Parker LLC, an ED coding and billing...

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