Billing Chemical Cardioversion

[suckstobeme]

Hey Guys-
I just learned a chemical cardioversion for SVT (using adenosine) is not a separate billable procedure. Not really that big of a deal, I suppose because generally involves just giving a push of adenosine.
I was talking with many of my colleagues who bill this as critical care, but generally it does take long enough to bill 30 minutes critical care time.
I was just wondering if anybody else is billing/coding this any different than I am. I think it's probably legitimate level 5 visit but that's about it.

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[Birdstrike]

Critical care 100% of the time, (as long as they spend at least 30 min in ED).

Unstable HR of 200....on monitor, given ACLS drug (adenosine). That's an un-defended layup, my friend. If you're not billing critical care for these you're throwing money in the garbage. It doesn't matter that it only took 31 minutes, or that it was "easy." Disposition doesn't matter. All that matters is,

1-30 minutes (not necessarily at bedside, can include documentation, watching monitor, looking up old records, anything...) and,

2- Life/limb threat (which is your extremely elevated HR, doesn't matter that it's narrow complex HR of 190 vs wide complex; billing rules are not to this level of complexity).

An SVT with HR high enough to get adenosine as long as you document properly (30 minutes, unstable and radically elevated HR, IV, O2, ekg, monitor, etc) will survive a billing audit for a critical care charge every single time. Unless your documentation sucks.

 

[EctopicFetus]

Agree with Bird. Actually I cant imagine a scenario where you would cardiovert and dc an SVT under 30 mins of being in the ED. I am sure you are aware bt the 30 mins isnt the "procedure" time, it is how much of your time was spent on this patient, that includes any prep, H&P bedside time (excluding time performing a procedure), discussion with family (often for codes), and charting.

This isnt a billable procedure but it sure is critical care.

A good quick primer as I found on the net.

The patient must be critically ill. This is defined as critical illness or injury that “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.”

• The provider must treat the critical illness using “high complexity decision making to assess, manipulate, and support vital systems to treat single or multiple vital organ system failure and/or prevent further life threatening deterioration of the patient’s condition.”

• The care requires the personal attention of the provider. Care must be provided at the bedside or on the floor/unit where the patient is housed.

• The care must be medically necessary. Treatment or management of a patient’s imminent deterioration is required.

 

[southerndoc]

I believe if you bill for critical care time under 30 minutes, it won't be billed as critical care, but will qualify the chart (no matter how much deficiency) as a level 5.

 

[Arcan57]

I believe if you bill for critical care time under 30 minutes, it won't be billed as critical care, but will qualify the chart (no matter how much deficiency) as a level 5.

My understanding as well. Also, that is definitely crit care.

 

[EctopicFetus]

I believe if you bill for critical care time under 30 minutes, it won't be billed as critical care, but will qualify the chart (no matter how much deficiency) as a level 5.

I believe you still have to hit the ROS etc. Those are minimum standards.

 

[Birdstrike]

I believe you still have to hit the ROS etc. Those are minimum standards.

Yep, otherwise bumps down to a 3 (not five).

 

[Arcan57]

Yep, otherwise bumps down to a 3 (not five).

That's not my interpretation of the critical care less than 30 min code.

 

[Birdstrike]

That's not my interpretation of the critical care less than 30 min code.

If less than 30 min can't use any CC codes. Defaults to E&M, which if you have no ROS, at all, it's tough to get past a level 3 E&M

See FAQ 3.

http://www.acep.org/Content.aspx?id=30466

 

[The White Coat Investor]

For sure critical care. They had a critical illness, you did something to fix it, and you spent 30+ minutes doing so (including charting and talking to a consultant.

I guess I never thought about it being a separate procedure.

 

[deuist]

How hard is it to check the box that says "all other systems are negative" or "history, physical, and review of systems are limited given the patient's condition?"

 

[suckstobeme]

Thanks for your input guys. I guess the reason why I didn't think critical care was applicable was b/c the pt really was only critically ill for like 12 min. I never called cards and documentation took like a minute (Thank you smartphrases). The pt was there for like 90min on a monitor while I checked K and Mg. I think I will be billing critical care for it in future.

 

[Birdstrike]

Thanks for your input guys. I guess the reason why I didn't think critical care was applicable was b/c the pt really was only critically ill for like 12 min. I never called cards and documentation took like a minute (Thank you smartphrases). The pt was there for like 90min on a monitor while I checked K and Mg. I think I will be billing critical care for it in future.

All STEMIs too, just make sure their time stamps show they were in the ED for 30 min, because those can easily slip through that fast (if they pass through you ED at all). Another "easy critical care" every time, if meets the time requirement.