tci ED Coding & Reimbursement Alert - 2005 Issue 5

Reader Questions: Query Doctor for Critical Care Time

Question: We have a critical care claim in which the physician's documentation meets all critical care documentation guidelines except the total critical care time provided. On the template, he circled "critical care" but didn't note the actual time spent. Should I send this chart back to the provider for completion, or should I use it as an educational tool for future use and just report a level-five service? My concern is that the payer may view sending the chart back for an addition of time as adding documentation for reimbursement purposes only.Illinois Subscriber Answer: You should certainly send...

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