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Top Physician Billing and Coding Issues: Critical Care and additional procedures

Critical Care requires that documentation identify the critical illness or injury being managed, the critical decisions made and the time spent by the ED providers to manage the critically ill or injured patient.  Documentation often fails to provide the time spent by the ED physician managing these patients.  More and more payers are looking for documentation of exact time, e.g. 32 minutes, rather than a range of time (31-35 minutes) spent managing the critically ill or injured patient.  In addition, the “split/shared” visit rules do not apply to timed services. Thus, the time spent by either the physician or the advanced practitioner (APP) can be used to support the critical service but not the elements of time spent by both and combined to bill critical care.  Regarding teaching physicians and residents, where services provided by the teaching physician with the assistance of residents is concerned, only the time spent by the teaching physician can be used to determine the total time spent.  The time spent by residents cannot be used towards meeting the time requirements for critical care.  The key to success is detailed documentation that indicates face-to-face interaction between the patient and the billing provider.  Documentation should discuss, presenting problem risk factors, ED course, orders and patient response, differential diagnoses and any additional thoughts or efforts to manage the patient.   Payer audits are increasing when APPs or Residents are involved in the service so be sure your documentation is detailed and complete. Some procedures are included in the Critical Care package, most are not.  Consult the 2018 edition of the CPT manual published by the American Medical Association for a listing of these procedures.