Medicare Compliance & Reimbursement - 2020 Issue 7
Critical Care: Count the Time When Reporting Critical Care
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Article Overview
This article is a coding refresher for emergency department and other billing professionals who report critical care services under CPT®. It explains the general scope of critical care reporting, highlights time documentation expectations, reviews services bundled into critical care, and discusses common situations such as bedside versus non-bedside time, discharge after critical care, and how documentation supports reporting. The piece is aimed at coders, auditors, and clinicians who need a clearer view of when critical care reporting may apply and what information must be present in the record.
Why This Topic Matters
Critical care reporting is highly time- and documentation-dependent, and the rules can affect whether a service is billed separately or bundled. Understanding the article helps readers recognize the major compliance and reporting considerations that commonly arise in ED and hospital settings.
Article Sections
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Check This Critical Care Refresher
Introduces the critical care topic, the CPT® framework, and the general documentation expectations for reporting this type of service. It also frames the article’s focus on common areas of confusion.
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Beware Services Bundled Into Critical Care
Summarizes categories of services that are addressed in the critical care guidance and discusses how bundled services are treated in the professional component. The section also notes the distinction between professional and facility reporting.
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Mind Time for Critical Care
Covers how time is documented and counted for critical care, including how reported time is measured within a date of service. It also addresses where time may occur and what kinds of activities may or may not be counted.
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Don’t Count on ROS, HPI
Explains the relationship between critical care reporting and the usual emergency department history and exam elements. The section focuses on the documentation framework used for time-based critical care reporting.
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In Some Cases, Discharge Can Occur Post-CC Service
Reviews scenarios where critical care services may still be reported even when the patient is discharged rather than admitted. It also discusses the importance of the patient record in supporting the service.
What You Will Learn
- How critical care is framed under CPT® in emergency and hospital settings
- What documentation themes are emphasized for time-based critical care reporting
- Which broad categories of services are addressed as bundled within critical care guidance
- How reported time is discussed for bedside and non-bedside critical care work
- Why discharge does not automatically exclude critical care reporting
- What kinds of record review issues can affect whether critical care is supportable
Who Should Read This
- Medical coders
- Coding auditors
- Emergency department billing staff
- Compliance professionals
- Physicians and other qualified healthcare professionals
Codes Discussed
Code Ranges Discussed
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