Outpatient Facility Coding Alert - 2019 Issue 7
Critical Care: Nail Down the Answers to These Pressing Critical Care FAQs
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Article Overview
This article reviews frequently asked questions about critical care reporting in the emergency department and other care settings. It summarizes general guidance from CPT and CMS on when critical care may be reported, how time and documentation factor into the service, and what broad circumstances can affect whether the service is billable. The piece is aimed at coding professionals who need a clearer understanding of critical care documentation and coverage considerations without relying on assumptions about setting or diagnosis.
Why This Topic Matters
Critical care reporting is a frequent source of coding uncertainty, especially when patients are discharged, treated outside the ED, or managed by multiple clinicians. Accurate understanding of the scope of the service helps coding staff align documentation review with published guidance and avoid incorrect reporting.
Article Sections
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Don’t Count on ROS, HPI
This section explains how critical care relates to general E/M documentation concepts and why it is treated differently from standard emergency department visit levels. It also discusses the broad documentation elements needed to support the service.
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In Some Cases, Discharge Can Occur Post-CC Service
This section addresses whether critical care can still be reported when a patient is treated and discharged from the ED the same day. It also covers the general role of diagnosis, documentation, and provider involvement in determining whether the service is supported.
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Can ED Physicians Report Services Outside the ED?
This section discusses whether the location where critical care is performed affects reporting. It also reviews the broader relationship between the service, time requirements, and other emergency interventions.
What You Will Learn
- How critical care is distinguished from standard emergency department E/M services
- What broad documentation concepts support reporting critical care
- Why discharge does not automatically preclude critical care reporting
- How location of service affects critical care reporting considerations
- How CMS and CPT guidance shape review of critical care claims
Who Should Read This
- Emergency department coders
- Physician coders
- Clinical documentation staff
- Revenue cycle professionals
- Compliance teams
Codes Discussed
Code Ranges Discussed
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