Critical care time fraud?

[Janders]

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Thats the pertinent language, that you cannot bill time (even charting time) unless you remain immediately available. In some settings, I’ve heard of ED MDs going to the cath lab for codes, etc. But MOST settings this does not happen, and the patient is fully signed out and not yours anymore.

This is similar to “talking to the family” counting as CC time. It actually doesn’t, unless the family is part of the decision making process. Just providing an update doesn’t count, and telling them their loved one died doesn’t count. So the code you run for 10 minutes, then end up talking to the family for 15 and charting for 5 doesn’t add up to 30min of CC per firm interpretation of the regs.

My own interpretation is that if a patient meets all other requirements of CC billing, and is in the ED >>20min, then I’m probably going to be comfortable billing 31min of CC including my charting, because no one has stop watches and when patients get “taken off the board” or move in epic isn’t THAT precise. I suspect an this would be defendable in audit if it (rarely) occurred in your coding.

But people who work at cath-capable hospitals, where the patient TRULY is in the ED for 5-7min and goes to the lab… I personally would not try to stretch that into 32min of CC because I’m “available” in the same building.

 

[RustedFox]

Thats the pertinent language, that you cannot bill time (even charting time) unless you remain immediately available. In some settings, I’ve heard of ED MDs going to the cath lab for codes, etc. But MOST settings this does not happen, and the patient is fully signed out and not yours anymore.

This is similar to “talking to the family” counting as CC time. It actually doesn’t, unless the family is part of the decision making process. Just providing an update doesn’t count, and telling them their loved one died doesn’t count. So the code you run for 10 minutes, then end up talking to the family for 15 and charting for 5 doesn’t add up to 30min of CC per firm interpretation of the regs.

My own interpretation is that if a patient meets all other requirements of CC billing, and is in the ED >>20min, then I’m probably going to be comfortable billing 31min of CC including my charting, because no one has stop watches and when patients get “taken off the board” or move in epic isn’t THAT precise. I suspect an this would be defendable in audit if it (rarely) occurred in your coding.

But people who work at cath-capable hospitals, where the patient TRULY is in the ED for 5-7min and goes to the lab… I personally would not try to stretch that into 32min of CC because I’m “available” in the same building.

Understandable. I didn't read the entire thread. I'm nightshift only, so that STEMI is mine for a good 20 minutes or so while cath lab gets here.

 

[RustedFox]

Thats the pertinent language, that you cannot bill time (even charting time) unless you remain immediately available. In some settings, I’ve heard of ED MDs going to the cath lab for codes, etc. But MOST settings this does not happen, and the patient is fully signed out and not yours anymore.

This is similar to “talking to the family” counting as CC time. It actually doesn’t, unless the family is part of the decision making process. Just providing an update doesn’t count, and telling them their loved one died doesn’t count. So the code you run for 10 minutes, then end up talking to the family for 15 and charting for 5 doesn’t add up to 30min of CC per firm interpretation of the regs.

My own interpretation is that if a patient meets all other requirements of CC billing, and is in the ED >>20min, then I’m probably going to be comfortable billing 31min of CC including my charting, because no one has stop watches and when patients get “taken off the board” or move in epic isn’t THAT precise. I suspect an this would be defendable in audit if it (rarely) occurred in your coding.

But people who work at cath-capable hospitals, where the patient TRULY is in the ED for 5-7min and goes to the lab… I personally would not try to stretch that into 32min of CC because I’m “available” in the same building.

Grief and after action counseling absolutely *should* count, IMO.

I'm not arguing with YOU, bro. You're right when it comes to : "this is the rule."

But it should.

I "bill" (or at least chart appropriately and use the correct diagnosis code) for substance use disorder counseling. Generally the "8-15 minutes was spent, etc" and then I discuss the relevant principles discussed (transtheoretical change model assessment, identification of associated disorders, cessation strategies, SUD related principles, etc.)
I have templates for these all.

I know some may find this difficult to believe, but I often work in FSERs in an area that is heavy with opiate and alcohol use disorder. I just hope the coders see this and collect approximately, as I'm hourly.

 

[Janders]

Grief and after action counseling absolutely *should* count, IMO.

I'm not arguing with YOU, bro. You're right when it comes to : "this is the rule."

But it should.

I "bill" (or at least chart appropriately and use the correct diagnosis code) for substance use disorder counseling. Generally the "8-15 minutes was spent, etc" and then I discuss the relevant principles discussed (transtheoretical change model assessment, identification of associated disorders, cessation strategies, SUD related principles, etc.)
I have templates for these all.

I know some may find this difficult to believe, but I often work in FSERs in an area that is heavy with opiate and alcohol use disorder. I just hope the coders see this and collect approximately, as I'm hourly.

💯

I’m purely playing rules lawyer. I fully agree that having a deep, traumatic emotional conversation with a family explaining a death should count as CC billing.

They don’t care about us. 🤷‍♂️

 

[emergentmd]

Not to rehash or debate. If you feel its CCT, then do it. The chance of someone coming back to declare fraud is about as common as if you deducted good will stuff for $100 when value was likely $75.

But if you take crazy liberties, you take the risks. If someone is in the ER for a STEMI 25 minutes, sure CCT makes sense and no one will argue. If they are in the ER for 10 minutes, then its not a risk I am willing to take.