Critical care has high relative value units and payments so it’s important to know the coding rules. This article describes what can be included in the time of critical care what can’t be included, and the time thresholds for reporting critical care.
The care of a critically ill patient billed based on time documented in the medical record.
Here’s how the Medicare Carriers Manual describes critical care in Chapter 12, Section 30.6.12 A:
Critical care includes the care of critically ill and unstable patients who require constant physician attention, whether the patient is in the course of a medical emergency or not. It involves decision making of high complexity to assess, manipulate, and support circulatory, respiratory, central nervous, metabolic, or other vital system function to prevent or treat single or multiple vital organ system failure. It often also requires extensive interpretation of multiple databases and the application of advanced technology to manage the critically ill patient.
Members can watch this brief overview, download the slides for reference, and read on for an in depth review of billing and coding guidelines, and tips for reporting Critical Care Services.
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