tci ED Coding & Reimbursement Alert - 2000 Issue 10

Case Study: Receive Optimum Payment For Critical Care

The coding of critical care services presents a challenge for emergency department coders because one or more of the required descriptors or indications of the urgent and critical nature of the care often are omitted from the physicians notes. The following case study provides an opportunity to revisit the qualifiers for coding critical care for the Medicare and non-Medicare patient.Chief Complaint: Elevated heart rate.HPI (history of present illness): The patient is a 42-year-old female brought in by EMS (emergency medical services) with a heart rate of 160 at the nursing home. They noted the patient to be...

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