Billing, Boarders, and COVID-19

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GatorCHOMPions

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We have a ton of boarders taking up space where I am just waiting for beds upstairs. On more than one occasion these patients decompensate, usually requiring some escalation in oxygen and occasionally I help them self-prone. Would these actions justify billing critical care time on these patients? Sometimes I do actually go back into the room a few times and maybe consult ICU for the inpatient team. In this particular example, the patient in question may have been admitted to an inpatient service for several hours already.

And then a separate question, what is your trigger for billing critical care on these patients when they are directly under your ordinary care in the ED? My loose criteria is anything more than nasal cannula O2 or if their saturation is below 90% at any time, but this is arbitrary.

Please reply with any supporting references if you know of any. Thanks

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CC time parameters still apply. If you are managing patients with severe hypoxemia / hypoxia, are you spending > 30 minutes critical care with them? Including chart review, documentation, talking to family, etc?

To me, if they are in the ED there is some level of care the ED is providing. It's not like you ignore them if they get worse.

If they were on the floor and they get worse, then it's not your problem. but if they are in the ED and they get worse, regardless if they are "admitted" or not, they are still your responsibility.

So bill CC if you meet the parameters, that's my opinion.

What state you in? Florida?
 
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