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Tip: Review critical care criteria for the ED

APCs Insider, October 16, 2015

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Coders may report critical care provided in the ED. Critical care is defined as the direct delivery of medical care by a physician or provider to a critically ill or injured patient.

Typically, in such a case, one or more vital organs or organ systems are impaired, and the patient's condition has a high probability of immediate deterioration. In addition, if critical services are not immediately rendered, the patient faces a high probability of death.

Delivering critical care in a moment of crisis or upon being called to the patient's bedside emergently is not the only criterion for providing critical care services.

While not necessarily emergent, treatment and management of a patient's condition under threat of imminent deterioration also meets the requirement. In such a case, failure to initiate interventions on an urgent basis would likely result in sudden, clinically significant, or life-threatening deterioration in the patient's condition.

This tip is adapted from “E/M reporting remains a challenge in the ED" in the October issue of Briefings on APCs.

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