Health Information Management

Q&A: Observe the correct CMS transmittal for facility/technical critical care

APCs Insider, October 10, 2008

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QUESTION:  Our facility is trying to clarify a recent CMS transmittal about Critical Care services. (Pub 100-04, Medicare Claims Manual, Transmittal 1548, CR 5993, July 9th 2008). Our questions are:

  •   Does this transmittal apply to facility critical care coding and reporting?
  • Must the facility require the ED physician to document critical care time in the medical record to charge critical care code 99291?
  • May the facility charge critical care code 99291 if the patient meets the hospital criteria for critical care and the record indicates that the patient was in ED more than 30 minutes? This code selection indicates that care for a critically ill patient involved use of ED resources. The critical care assignment is based on nursing and other hospital staff resource utilization.

ANSWER:  The transmittal you cite refers to the professional/physician component for claims instruction and submission. CMS provided facility/technical critical care clarification of time requirements in Publication 100-04, Transmittal 1139, OPPS Summary of Changes, January 2007. p. 13. To view the entire transmittal, click here.

 



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