tartesos

Medalaganario
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This is a place to ask questions and share experiences.
I know it's not the most exciting of topics, and it's not taught in training well and ignored( because it's boring) but it's a necessity.
This marks the beginning of our journey.


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Hernandez

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group_theory

EX-TER-MIN-ATE!'
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You can't bill critical care time if you downgrade the patient from ICU level care to step-down or floor. I'm sure there are exceptions, but it is hard to meet the requirement of "critical care time" as defined by medicare, and at the same time write that the patient is OK to transfer out of the ICU.

Medicare defines critical care time as "the failure to initiate these interventions on an urgent basis would likely result in sudden, clinically significant or life threatening deterioration in the patient's condition".

The Medicare Auditors are starting to crack down on critical care time billing on patients who are in the ICU "just because that's what policy is" but don't really need critical care intervention. For example, if you have a patient with a chronic trach/vent, who has cellulitis and getting IV abx (and in the ICU only because of the chronic trach/vent) ... if there are no active airway issues, and you are just treating cellulitis, an auditor would flag you as overbilling by using critical care time.
 
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tartesos

tartesos

Medalaganario
7+ Year Member
Jan 24, 2011
7,344
8,232
Next to the middle of nowhere.
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Attending Physician
So I learned something today that came up after I saw some billing charges as a level 2 consult and 1 1/2 hrs of Ccm together.

You can do a consult( or progress note etc) same day first and if you later on do a ccm note you can bill for both same day.

If you bill ccm time first, then you cannot bill another note( consult f/u or progress note) the same day, but you may add on critical care time if you keep taking care of the patient.

Please correct me if wrong and chime in!


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Hamhock

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May 6, 2009
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You can't bill critical care time if you downgrade the patient from ICU level care to step-down or floor. I'm sure there are exceptions, but it is hard to meet the requirement of "critical care time" as defined by medicare, and at the same time write that the patient is OK to transfer out of the ICU.
I do this fairly frequently.

Afib RVR who is chemically cardioverted (nevermind electrically) with a drip -- or even just gets rate control...I often write, anticipate transfer to the tele floor and bill critical care time.

Pulmonary edema on NIPPV but just needs a bit more afterload reduction and diuresis. Off NIPPV by mid-day and then I write OK to transfer to the floor.

Post-op patient who anesthesia says they "just couldn't safely extubate" (usually near the end of the day)...propofol off, extubate, send to the floor and bill for critical care time.

I have lots more examples. You are billing for your critical care, which is often the reason the patient can be downgraded. Do you not bill for critical care when called to the floor for a potential ICU patient who you can stabilize and prevent the transfer on?

Location or bed assignment does not define critical care.

HH