tci E/M Coding Alert - 2016 Issue 11

Reader Question: Go By the Book on Critical Care Claims

Question: CPT® states that a patient must be “critically ill or injured” in order to use critical care codes. Could you briefly explain what “critically ill or injured” means, and give me some examples of conditions that may warrant critical care? Delaware Subscriber Answer: According to the CPT® manual, a critical illness or injury “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.” In other words, critical care occurs when the patient’s condition is so tenuous that...

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