CMS Transmittal 1530 which became effective July 7, 2008, clearly defines and will assist physicians and coders with the process of determining when and how to utilize critical care codes correctly. Physicians need to be diligent about documenting encounter specifics when billing critical care codes.
One area that the transmittal defines is Family Counseling Discussions. Critical care services include pre and post service work. Routine daily updates or reports to family members and or surrogates are considered part of this service. If a physician meets with a patient’s wife and gives a 3 minute update, this cannot be counted towards critical care time. Time can be counted when these specific criteria are met:
- When the patient is unable or too cognitively impaired to give a medical history or make treatment decisions. You can count time spent consulting the family toward critical care.
- Time spent discussing treatment decisions, if the physician has to ask a family member about any allergies to medication, for example.
When documenting family counseling the physician must include the following in the medical record documentation:
- The patient is unable or incompetent to participate in giving history and/or making treatment decisions.
- The necessity to have the discussion, (i.e. the patient was deteriorating rapidly and treatment options had to be discussed with a family member).
- Medically necessary treatment decisions for which the discussion was needed.
- A summary in the medical record that supports the medical necessity of the discussion.
For any given period of time spent providing critical care services, the physician must devote his or her full attention to the patient and therefore cannot provide services to any other patient during the same period of time. All family meetings must occur on the patient’s unit/floor so that the physician remains immediately available to the patient.
The bottom line to remember in reporting CPT code 99291 is that the physician needs to spend a minimum of 30 minutes providing critical care to a patient with a critical illness or injury. Also remember that CPR, chest tubes, and wound repair are separately billable when provided with critical care.
If you need any additional information on this article or Coding & Compliance services, please contact Cindy Tipton at Cindy_Tipton@MED3000.com
For a printable version, click: CCNewsletterJuly2008
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