tci ED Coding & Reimbursement Alert - 2000 Issue 11

Rules for Determining Critical Care on the Basis of Time

By Caral Edelberg, CPC, CCS-PPresident, Medical Management Resources Inc.Consulting EditorBilling for critical care services in the emergency department (ED) continues to be confusing for many coders. A review of the basic differences between the Health Care Financing Administration (HCFA) and American Medical Association (AMA) policies will help clarify the issue.Medicare Policy for Critical Care HCFA Transmittal B-99-43, dated December 1999, explains the criteria for documentation and coding of critical care services (99291-99292) brought about by the modifications in CPT 2000.For 2000, CPT redefines a critical illness or injury as one that acutely impairs one or more...

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