BC Advantage - 2015 Issue 2

5 keys to critical care coding

Critical care is the most highly compensated E/M service, but it's also the most highly scrutinized by payers. Under the relative value unit (RVU) formula used by Medicare to determine payments, critical care services are paid more than high-level inpatient hospital admissions (99223) and high-level emergency room services (99285).Their high value means critical care codes get a correspondingly high level of auditor attention, so you must understand what a properly billed critical care service looks like, including the documentation and time requirements.CPT defines critical care in this way: "...direct delivery by a physician(s) or other qualified...

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