Critical care medicine is also called intensive care medicine. This specialty concentrates on the specific patients who require urgent care and consistent monitoring because they are at risk of a life-threatening condition. Here are some of the most common urgent conditions that require critical care:
- Sepsis
- Serious Injury
- Brain Trauma
- Organ Failure
- Heart Problems
- Lung Problems
- Drug-Resistant Infections
There is an increase in the volume of such critical cases, which are serious and very complex. That is why critical care experts have to provide fast responses to these situations. In addition to that, critical care professionals should also be knowledgeable about such services’ medical billing and coding. But as they are already in a situation that requires a lot of attention, many practices outsource these services from Control Billing. This well-known medical billing company provides the best billing and coding services.
Before moving towards the billing and coding of critical care medicine, let us define it!
What Is Critical Care?
We can define critical care as the medical care that physicians provide to a critically ill or unstable patient. In a critical illness, one of the important organ systems is at risk, which means that the patient is at risk of a life-threatening situation. The conditions that require critical care include failure of the nervous, circulatory, respiratory and renal systems.
Billing And Coding Of Critical Care Services
Here are some of the basics of medical coding and billing that the best medical billing company must follow:
Billing basics of critical care
To code the services provided by the staff of critical care, the coder can use the following codes:
- 99291: It is used for the evaluation & management for the first 30-74 minutes of critical care.
- 99292: It is used for every additional 30 minutes for critical care.
It is important to at least spend 30 minutes attending to the patient. It does not imply offering continuous attention staying by their bedside; instead, one can bill for the following time spent in critical care:
- The time physician spends staying at the bedside of the patient.
- The physician’s time on patient care includes consultations, reviewing records, and other lab results.
- The time the physician spends with the family to get the medical history or discuss the treatment should be provided.
In addition, the following critical care services should also be counted as the time that is spent in providing critical care:
- pulse oximetry (94760-94762)
- gastric intubation (43752, 91105)
- temporary transcutaneous pacing (92953)
- interpretation of chest X-rays (71010-71020)
- interpretation of cardiac output (93561-93562)
- ventilator management (94002-94004, 94660, 94662)
- vascular access procedures (36000, 36410, 36415, 36450, 36600)
The services mentioned above can’t and should not be billed separately. Still, it is important to keep track of the critical care time you spend while performing them. Services other than the above are usually billed separately, and these services may include CPR and other such services. It should be ensured that the time you spend performing them should not be calculated with the total critical care time.
Separately billable critical care services include the following codes:
- 92950: used for CPR services (while being performed)
- 31500: used for endotracheal intubation
- 36555, 36556: used for central line placement
- 33210: used for temporary transvenous pacemaker
- 93010: Electrocardiogram (ECG)
It should be noted that time spent on the critical care services is the guiding principle in the documentation of such services. The critical codes can only be used when the total time spent providing critical care is documented. Additionally, the critical codes are billed at a higher rate than other E/M service codes.
Complex billing cases in critical care
Critical care billing also includes some complex billing cases that compel the medical practices to opt for outsourcing from a medical billing company! Let us explain to you complex billing cases with an example. Let’s imagine there is a patient named Mr. Peter who is admitted with septic shock on the first day.
He has unstable blood pressure and requires gastric intubation. This incubation admission takes about three hours. In such a case, you should code 99223 for the admission and bill for the critical care services you provided. The time spent on admission functions like history and physical should be subtracted from the critical care time to calculate the critical care time, which is time spent on stabilizing the patient in order to avoid an imminent or life-threatening condition.
The vent management ((94656) is included with the critical care and is not billed separately. While performing the vent management, keep on calculating your critical care timing, and this time will be counted in your total critical care time.
Other services, other physicians in critical care
Let us take the example of Mr. peter and say that on day 2, a code is called, and CPR (92950) is performed. The code runs, and when you order further CPR for 31 minutes. The total time is 90 minutes standing either at the bedside or at the nurse’s station. One can bill a critical care code (99291) and a CPR code (92950) in this scenario. The 31 minutes spent on performing the CPR should be subtracted from the total care time of the physician.
What Services are included in CPT Codes 99291 and +99292?
As mentioned before that the CPT codes 99291 and +99292 should not be billed separately. Here are the services and CPT codes that The American Society of Anesthesiologists lists:
- 36000: Introduction of needle or intracatheter, vein
- 36410: Venipuncture, age three years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure) for diagnostic or therapeutic purposes (not to be used for routine venipuncture)
- 36415: Collection of venous blood by venipuncture
- 36591: Collection of blood specimen from a completely implantable venous access device
- 36600: Arterial puncture, withdrawal of blood for diagnosis
- 43752: Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation, and report)
- 43753: Gastric intubation and aspiration(s) therapeutic, necessitating physician’s skill (e.g., for gastrointestinal bleeding), including lavage if performed
- 71045: Radiologic examination, chest; single view
- 71046: Radiologic examination, chest; 2 views
- 92953: Temporary transcutaneous pacing
- 93561: Indicator dilution studies such as dye or thermodilution, including arterial and/or venous catheterization; with cardiac output measurement (separate procedure)
- 93562: Indicator dilution studies such as dye or thermodilution, including arterial and/or venous catheterization; subsequent measurement of cardiac output
- 94002: Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day
- 94003: Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day
- 94004: Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; nursing facility, per day
- 94660: Continuous positive airway pressure ventilation (CPAP), initiation and management
- 94662: Continuous negative pressure ventilation (CNP), initiation and management
- 94760: Noninvasive ear or pulse oximetry for oxygen saturation; single determination
- 94761: Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)
- 94762: Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure)
Ref.link: https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/reporting-critical-care-services
Let us wrap it up!
It is hard to ensure accuracy in critical care medical billing because there are many rules and regulations that should be followed. Due to these challenges, many healthcare facilities tend to outsource these services to an affordable and professional medical billing company! For error-free claim submission and optimal reimbursement, contact UControl Billing now!
