Medicare Compliance & Reimbursement - 2015 Issue 10
Reader Question: Don't Assume ICU Means Critical Care
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Article Overview
This reader Q&A addresses a common inpatient coding misconception: that care delivered in an ICU can automatically be reported as critical care. It is useful for coders, billers, auditors, and clinicians working with hospital evaluation and management services because it discusses the general criteria associated with critical care, the need for time and medical decision-making documentation, and the alternative hospital care categories that may apply when critical care is not supported.
Why This Topic Matters
Correctly distinguishing ICU rounding from critical care helps avoid unsupported claims and improves accuracy in hospital E/M reporting. The article provides a practical, nontechnical explanation of the broad documentation concepts that drive code selection in this setting.
What You Will Learn
- How critical care differs from simply seeing a patient in the ICU
- What broad documentation elements are associated with critical care reporting
- When hospital care services may be considered instead of critical care services
- Why place of service alone is not enough to support critical care billing
Who Should Read This
- Medical coders
- Billing staff
- Compliance auditors
- Physicians
- Hospital documentation specialists
Codes Discussed
Code Ranges Discussed
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