Billing Critical care with B52

[Pudortu]

Can you bill critical care if a patient is acting a fool and needs to be put down with Benadryl/Ativan/Haldol?
I mean serial reassessments are required so I was hoping to see if I could bill with these patients?

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[southerndoc]

I don't think so. I've billed critical care for a few patients that required ketamine and the coders have always kicked it back and downgraded it to a level 5. At my facility, ketamine for excited delirium requires continuous cardiac monitoring, pulse oximetry, and is treated as if a procedural sedation was performed.

 

[Fox800]

A single shot of an antipsychotic? Nah.

IM ketamine for refractory agitation requiring cardiac monitoring, ETCO2 monitoring, labs, and frequent reassessments of cardiovascular and neurologic status? That, amigo, is critical care.

 

[BoardingDoc]

One 5+2 doesn't = CC time in my mind. IM ketamine certainly might, depending on the circumstances. Multiple doses (e.g. 5+2 for agitated delirium which doesn't work and requires additional doses) = CC time in my book.

 

[clibby]

Single administration, even of multiple meds = nah.

If you have to re-dose, now you are worried about respiratory depression, rhabdo, cardiac arrhythmias and you have them on a pulse ox and cardiac monitor. That = cc time.

 

[WilcoWorld]

If you give the B52 because you're concerned about a critical condition and then do a workup to assess for those life threats - I think you could bill CC time so long as the presentation was reasonably concerning for life threatening illness.

But giving a regular a B52 because they dropped too many F-bombs, nah.

 

[Pudortu]

Oh well I tried. My ship moved to RVUs and I’m trying to figure out tricks to document critical care. Thanks all.

 

[southerndoc]

Oh well I tried. My ship moved to RVUs and I’m trying to figure out tricks to document critical care. Thanks all.

Always best to ask before doing it. I've known of docs billing critical care for TIA's and appendicitis. That, in my opinion, is begging for an audit and could land you in serious trouble with CMS/DOJ if you're caught.

I thought ketamine for someone wigging the F out requiring restraints, continuous monitoring, and also requiring benzos (gotta love meth in the south) would qualify for critical care. Coders said no bueno, level 5 is all you get.

 

[BoardingDoc]

Always best to ask before doing it. I've known of docs billing critical care for TIA's and appendicitis. That, in my opinion, is begging for an audit and could land you in serious trouble with CMS/DOJ if you're caught.

I thought ketamine for someone wigging the F out requiring restraints, continuous monitoring, and also requiring benzos (gotta love meth in the south) would qualify for critical care. Coders said no bueno, level 5 is all you get.

Gotta say, I completely disagree with your coders on this one, and am pretty sure that mine would push that through as a CC chart without blinking an eye.

 

[DeadCactus]

Coders play by Price Is Right rules. They generally want to never overcode more than they want to maximize coding.

The drug does not make critical care. Standing in front of the patient continually reassessing their vital signs, mental status, and response to medication while evaluating for life threats, coordinating the care team, and reviewing diagnostic results makes critical care. If you tell nursing to give medications and then wander away to see minor laceration patient, that’s not critical care. If you’re in a room with the patient being held down, waiting for meds to kick in, watching their respiratory status, and deciding if you need another dose then that is critical care time.

 

[Tenk]

If we could we’d all be millionaires.

 

[Groove]

I'd have no problem billing CC for that. It's all in how you document.

 

[Groove]

This is a smart phrase that I use underneath the CC part for "iffy" cases that I still think qualify for CC. I rarely get a kick back when I use it.

"This patient is critically ill with a life threatening disease process expected to cause imminent deterioration without life saving interventions. Time spent on critical care included interview, exam, formulation of diagnostic and treatment plan, bedside interventions, review of records, re-examinations, discussion with patient and or patient family members, admitting physician and appropriate sub-specialties and admitting orders."

 

[Goro]

In looking at the title of the thread, my thought was this:

 

[Apollyon]

In looking at the title of the thread, my thought was this:

Various terminology. There is the "Area 51" (5+1), the "B-52" (5+2), and the "10-4, good buddy!" (10+4), among others.

 

[deleted6669]

Also, you can take them to the BAR (Benadryl/ativan/reglan) then call them a CAB (Compazine/ativan/benadryl) for the cannabinoid hyperemesis folks who claim to be allergic to haldol and droperidol.