tci ED Coding & Reimbursement Alert - 2004 Issue 4

Reader Question - Tread Lightly: Depression and Critical Care

Question: Can I report a critical care code when the diagnosis is a mental illness, such as severe depression?Florida Subscriber Answer: Many Medicare carriers have local medical review policies for 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) that outline the acceptable diagnoses for the code. Unfortunately, severe depression is not on many of these lists. For non-Medicare patients, you would need some justification that the severe depression put the patient at risk for "a high probability of imminent or life-threatening deterioration in the patient's condition," according to...

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