Medicare Compliance & Reimbursement - 2020 Issue 10
Reader Question: Get Critical With This Threshold Guideline
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Article Overview
This reader Q&A discusses a time-based critical care reporting issue for a pulmonology scenario and explains the general threshold framework that determines when critical care reporting applies. It is written for coders, billers, auditors, and clinicians who need to understand how brief critical care encounters are evaluated and how an alternative E/M service may be considered when the threshold is not met.
Why This Topic Matters
Accurate reporting of time-based critical care services affects compliance, claim accuracy, and selection of the appropriate evaluation and management service level.
What You Will Learn
- How critical care reporting is tied to time thresholds
- How to think about alternative E/M reporting when critical care criteria are not met
- Why documentation and reported time matter in inpatient pulmonology scenarios
- How a reader question format addresses a common coding concern
Who Should Read This
- Medical coders
- Professional billers
- Compliance auditors
- Physician documentation staff
- Pulmonologists and other inpatient clinicians
Codes Discussed
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