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Tag Archives: Critical

Newborn NAS on mophine…considered critical care?

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Good morning-

If a newborn (28 days) is being treated in the nicu for NAS (neonatal withdrawal syndrome) with morphine, and no other issues…should it still be coded as critical care? And if so, is there anywhere to find any confirmation (CMS website?) that it should be coded as such? Or, would it just be an intensive weight based code?

-Thanks all

Medical Billing and Coding Forum

Critical Access Billing Question

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The critical access hospital where I work is billing with Method II.
they have a wound care center and the doctor there is now an employee of the hospital.
He has agreed to reassignment of his billing rights to the CAH and agreed to the optional payment method HE/SHE will not be billing for any professional services provided.
However, the CAH wants to bill on the 85X the facility TC say like a debridement and then under the revenue center of 0960 professional clinic bill for the debridement.
I went to the Medicare Pub regulations for CAH posted on the CMS website and found language:

Payment to the CAH for each outpatient visit (reassignment billing) will be the sum of the following:
For facility services, not including physician or other practitioner services, payment will be based on 101 percent of the reasonable cost for the outpatient services less applicable Part B deductible and coinsurance plus:

Show the professional services separately, along with the appropriate HCPCS code (physician or other practitioner) in one of the following revenue codes- 096X, 097X or 098X.

so I take it as the facility can bill on one 85x form the same code twice one for the TC of the CAH facility and the same code for the professional fee.

Example: revenue center 0510 CPT 97594 Debridement for the technical (facility charge) and revenue center 0960 CPT 97594 debridement for the professional charge for the procedure.

Medical Billing and Coding Forum

Critical Care Coding Questions

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Physician A bills a critical care code.
Physician B bills an E/M hospital initial or subsequent code for the same patient and the same day. Is this billable by both MD’s?

It is understood that rounding in the CC unit and billing a subsequent hospital care code is feasible as long as it in not related to an operative procedure (non-global care)but can 2 physicians from the same group bill on the same day for the separate services?

Medical Billing and Coding Forum

Critical Care requirements for Neurologists

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My neurologists that see patients at a nearby hospital (usually being consulted on ER cases) have a question about requirements for billing Critical Care (99291-99292). I’ve given them the guidelines from the current CPT book that state that "providing medical care to a critically ill, or injured, or post-operative patient qualifies as a critical care service only if both the illness or injury AND the treatment being provided meet the above requirements". They are arguing that at times, the patient’s illness meets the critical guidelines, but no treatment is given. Based on the book guidelines, this would not meet the CC guidelines, but they feel that the intensity of the service/severity of the patient’s condition should still meet the guidelines. Some examples are if the patient is in status epilepticus, myasthenia gravis crisis, hypoxic brain injury due to cardiac arrest, encephalitis. The most common example of when they do meet the CC guidelines is stroke patients who have TPA ordered. Can anyone give any insight or documentation that would agree with their opinion that these patients qualify for CC codes even though they don’t meet the book guidelines?

TIA!!

Medical Billing and Coding Forum

Critical Care and ESRD

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I know that organ system failure is essential for coding critical care but I’m having difficulty agreeing with the provider to bill critical care when the only organ failure documented is “severe ESRD” since in this patient the ESRD has been a long established chronic condition. Does anyone have any insight/experience using ESRD to substantiate critical care?

Medical Billing and Coding Forum

Neonatal Critical Cares services by NP/PA

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I am new to auditing neonatal critical care services and I am hoping there is someone who could answer a few questions for me.

1. Can neonatal critical care services be "shared visits" and billed under the MD’s name and NPI number?
2. If they can be shared doesn’t the MD need to document they portion of the visit and not just attest to the work and documentation done by the NP/PA?
3. Can NPs/PAs bill for neonatal critical cares services independently?

Any information anyone can shared on this topic would be greatly appreciated.

Anna Maria

Medical Billing and Coding Forum

Critical and Cardioversion

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I’m needing some help…. One of my providers is wanting to bill 99291 and 99292 (total of 85 minutes), he also wants to bill 92960 x’s 2…..I was under the impression that 92960 is elective and not billable as an urgent procedure. These were some of the key words he used: Unstable Narrow Complex Tachycardia with successful restoration of NSR
Consent: None (medical necessity), DCCV had to be done urgently due to hemodynamic compromise secondary to the arrhythmia. Any help will be appreciated!

Medical Billing and Coding Forum

Critical Care Audit Question

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I am currently auditing Critical Care Services and there is a physician who provides the EHR signed document that does not indicate that it is a Critical Care document, but will then Write using a normal pen on the bottom of the last page stating the total time spent providing critical care services. Would this validate the use of Critical Care billed services? The provider does not initial the area that he wrote on the document or provide an addendum on the document. It just looks like he printed the document then later wrote in the total time spent.

I don’t think that this validates, but just need some clarification and input please?

Thank you
Christina

Medical Billing and Coding Forum