Japan Former PM Shinzo Abe Resuscitation Discussion

[Kryptocoin]

Probably still billed for CC, though? (no shame. I def would have)

I'm straight hourly, no RVUs, so I didn't. I would have, though, if I were RVU.

---

Members don't see this ad.

 

[WilcoWorld]

FYI: Only one person can bill CC for the same time.

 

[PTPoeny]

FYI: Only one person can bill CC for the same time.

My understanding is physicians from different specialties can bill for concurrent critical care the if they document they are providing different aspects of care.

ie: I have had a cardiologist bill critical care time for cardioversion while I was billing critical care time for the rest of the resuscitation -ie fluid replacement, electrolyte replacement and vasoactive titration

 

[Siggy]

My understanding is physicians from different specialties can bill for concurrent critical care the if they document they are providing different aspects of care.

ie: I have had a cardiologist bill critical care time for cardioversion while I was billing critical care time for the rest of the resuscitation -ie fluid replacement, electrolyte replacement and vasoactive titration

Technically speaking, and it may have changed with the rules overhaul this year (for example you can now split-share time), only one person could bill at a specific time. The bigger issue is how would they determine who was billing for which minute?

 

[WilcoWorld]

My understanding is physicians from different specialties can bill for concurrent critical care the if they document they are providing different aspects of care.

ie: I have had a cardiologist bill critical care time for cardioversion while I was billing critical care time for the rest of the resuscitation -ie fluid replacement, electrolyte replacement and vasoactive titration

I'm no expert, so take this with some NaCl, but the cardioversion would be a procedure & should thus not be part of CC time.

You could both bill CC during the same encounter, but it couldn't be concurrent. Your CC time went from 1800-1835 & Cards' went from 1836-1920, for instance.

 

[Siggy]

I'm no expert, so take this with some NaCl, but the cardioversion would be a procedure & should thus not be part of CC time.

You could both bill CC during the same encounter, but it couldn't be concurrent. Your CC time went from 1800-1835 & Cards' went from 1836-1920, for instance.

Scheduled cardioversion has a CPT code. Emergent cardioversion is bundled into CCT time from my understanding.

Also, from my understanding, when it comes to procedures you have a choice of billing critical care time or billing the procedure. For the vast majority of times you’re better off billing the procedure than CCT.

However the most common time that CCT time is billed instead of a procedure is POCUS. You could bill, for example, a limited echo and limited chest ultrasound for patients, but then you’d have to generate and store images of your views.

Or you can just describe your findings and count it towards your CCT because unless you’re set up for a proper report, the process isn’t worth the time.

 

[turkeyjerky]

Interesting. For clarification, say a typical afib w/ rvr comes in and you cardiovert. Would you then bill for a 99285 (level 5 visit) as well as a 92960 (external cardioversion) for 4+2.25=6.25 wRVUs? This vs a 99291 (30 min CC) for 4.5 wRVUs.

 

[Siggy]

Interesting. For clarification, say a typical afib w/ rvr comes in and you cardiovert. Would you then bill for a 99285 (level 5 visit) as well as a 92960 (external cardioversion) for 4+2.25=6.25 wRVUs? This vs a 99291 (30 min CC) for 4.5 wRVUs.

I guess the question is did you have enough time to do a proper implied consent? If they're stable, likely you can do the former. If they're unstable and you essentially hooked them up and zapped them under implied consent then likely not, if for no better reason than because there's no code for emergent cardioversion.

Coding forum conversations on this:

Wiki - Emergent External Electrical Cardioversion

I have run into a problem with an electrical cardioversion (see above description), CPT code 92960. The patient was unable to provide informed consent due to current physical condition/intubation/etc. As the 92960 is defined in the CPT book as being an "elective" procedure, does it require an...

www.aapc.com

"Electrical cardioversion involves a physician applying a shock to convert to a rhythm, and it is a separately reportable service, coded 92960 Cardioversion, elective, electrical conversion of arrhythmia; external, when certain criteria are met. The code description states “elective cardioversion,” which indicates it’s not an emergent procedure.
Documentation indicating the procedure was elective would include a noted discussion with the patient for consent and sedation. Another indication that the procedure was elective is a notation of synchronization, which involves a shock delivered at a specific time. The non-emergent status allows for the additional time. Emergent cardioversion or defibrillation is not a separately reportable service. Defibrillation is included in the cardiopulmonary resuscitation service."

Account for Complex Procedures in the ED

Accurate reporting requires identifying all procedures performed beyond the initial E/M. By Sarah Todt, RN, CPC, CPMA, CEDC Physicians in the emergency

www.aapc.com

 

[WilcoWorld]

I guess the question is did you have enough time to do a proper implied consent? If they're stable, likely you can do the former. If they're unstable and you essentially hooked them up and zapped them under implied consent then likely not, if for no better reason than because there's no code for emergent cardioversion.

Coding forum conversations on this:

Wiki - Emergent External Electrical Cardioversion

I have run into a problem with an electrical cardioversion (see above description), CPT code 92960. The patient was unable to provide informed consent due to current physical condition/intubation/etc. As the 92960 is defined in the CPT book as being an "elective" procedure, does it require an...

www.aapc.com

"Electrical cardioversion involves a physician applying a shock to convert to a rhythm, and it is a separately reportable service, coded 92960 Cardioversion, elective, electrical conversion of arrhythmia; external, when certain criteria are met. The code description states “elective cardioversion,” which indicates it’s not an emergent procedure.
Documentation indicating the procedure was elective would include a noted discussion with the patient for consent and sedation. Another indication that the procedure was elective is a notation of synchronization, which involves a shock delivered at a specific time. The non-emergent status allows for the additional time. Emergent cardioversion or defibrillation is not a separately reportable service. Defibrillation is included in the cardiopulmonary resuscitation service."

Account for Complex Procedures in the ED

Accurate reporting requires identifying all procedures performed beyond the initial E/M. By Sarah Todt, RN, CPC, CPMA, CEDC Physicians in the emergency

www.aapc.com

The electrophysiologists had a seat at the table when it came to writing this book...and they continue to make bank as a result.