What do you include in your critical care time? Say a patient is septic. You evaluate the patient (10 minutes), you place orders (5 minutes), labs come back 2 hours later. You review the results (5 minutes) and call the hospitalist to admit (5 minutes). Then you document (10 minutes)
Do you count that as 10 + 5 + 5 + 5 + 10 = 35 minutes of critical care? Or is it closer to 2 hours and 35 minutes because of the 2 hours of waiting for results to come back?
"Physician/QHP time for critical care services encompasses time spent engaged in work directly related to the individual patient’s care, whether that time was spent at the immediate bedside or elsewhere. For example, time spent can be at the bedside, reviewing test results, discussing the case with staff, documenting the medical record, and time spent with family members (or surrogate decision makers) discussing specific treatment issues when the patient is unable or clinically incompetent to participate in providing a history or making management decisions. The time involved in activities that do not directly contribute to the treatment of the critical patient may not be counted toward the critical care time. The "critical care accrual clock" pauses when separately reportable procedures or services are performed; these should not be included in the total time reported as critical care time."
As above, you ABSOLUTELY will hit 30-40 minutes on actual critically ill patients. And probably 10% of your patients are "critical".
10 minutes at bedside or talking to family or EMS, including history, physical exam, and coming back later w/ plan/results
10 minutes entering orders and then reviewing all the results including imaging
5 minutes doing chart review
5 minutes talking to the hospitalist, or any specialist(s)
5-10 minutes charting.
People who DON'T think they spend 30 minutes on critical patients befuddle me. If doing 2 patient per hour is reasonably busy for us... we'd be spending 30 minutes on EVERY patient
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I do bill for the "second hour" of critical care, but certainly in minority of patients. Usually it is very sick w/ multiple pressors, or extended ED stay where they decompensated / boarded, or difficult transfer where I speak to 7+ hospitals trying to get these accepted. Occasionally when its a big 45min resus and then the family comes and then we have a big family talk and move to de-escalation I also easily hit 75minutes. It takes 1-2 minutes to document how you spend any extra 40+ minutes on these activities.
The big mistake people make is that they think the act of intubating or placing a line is part of the critical care time. It isn't. But I'm sure you still spent 30 OTHER minutes on those patients. It also doesn't count true education (like if you spend 20 minutes telling the med student about hyponatremia...).
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