I would appreciate some feedback on coding ER Critical Care for the facility side as I am coding for a new situation. The patients have been transferred from one ER dept to a second for a higher level of care. The patients have been diagnosed & possibly treated at the first ER dept but need a neurosurgi or other consult and are then generally admitted at the second hospital. They may undergo full body CT scans & receive IV meds at the second ER dept in addition to a neurosurgi consult or they may just have the consult. I am coding for the second ER facility which follows adapted ACEP facility level coding guidelines. The dxs the trauma patients have include subdural hematoma or vertebral fx unstable or pulmonary contusion or a combination of fxs and head & body injuries.

My question is whether the visit at the second ER dept qualifies for critical care. The guidelines say that possible critical care interventions include ‘major trauma care/multiple surgical consults’. The ER MD is stating critical care has been provided at the second ER so this along with the dx tells me that there is much concern for ‘life threatening deterioration in the patient’s condition’. I am unsure whether neurosurgi consult alone is enough to qualify for critical care especially as the patients have been stabilized to a degree at the first hospital. The cases I am struggling with are NOT the ones where the patient requires emergent endotracheal intubation or CPR, etc. I would like to understand better what constitutes ‘major trauma care’.

I welcome your thoughts on this topic. Thank you,

Ellen