Critical Care with family meeting..

I was asked the question by one of my MD that provider critical care for our ICU trauma patient.. Twice a week schedule family time meetings are held with pt. imediate family, social work, nurse and any other persons involved in case to discuss pt plan & options. and meeting is documented with what happen and who attended.Can these family meetings be billed along with the critical care cpt 99291 and if so what cpt code is used for such a meeting that takes place in the floor conference room.

Well

First, I hope you are not implying that you bill the critical care code for every visit of a patient in the ICU. That is wrong.

Second, if the patient is not present, you can bill for hospital visits "time spent on the hospital floor and unit" but that cannot count to the critical care time- it is not critical care but routine hospital care.

So, really, you should bill 99231-99233 based on time spent for each of these days, documenting time in the chart, and if a patient is critically ill and gets "critical care" then bill the critical care code and not the other code.

critical care

All of the patient in the ICU are critical ill, once they are no longer critical ill they are transfer to a regular floor..so the critical time for all patient that are critical ill is correct..I am questing can there be separate billing for family meetings..as far as the mental status of the patient i would have to ask if they are intubated/coma and if so can this time be billed for example..bill the critical care time 99291 (and the extra 30 99292 or if the family meeting last an hour..99292 x2

family

Medicare also has clarified that physicians may include time with the patients family to get the patients history or discuss treatment, but only if three criteria are met:
1. The patient is incompetent to provide information;
2. The patient is unable to provide information; and
3. The discussion with the family is absolutely necessary for the physician to make a decision on care.
All three of these conditions must be documented in the physicians daily progress note, which, Medicare stresses, must link the family discussion to a specific treatment issue and explain why the discussion was necessary on that day. All other family discussions, no matter how lengthy, may not be counted towards critical care time.

I beg to differ

[All of the patient in the ICU are critical ill, once they are no longer critical ill they are transfer to a regular floor..so the critical time for all patient that are critical ill is correct..]


This is not correct! I am sorry to be the bearer of bad news. There are many patients in the ICU who are not critically ill- the COPD patient stable on the vent, the acute MI post-stent being watched 24 hrs post-cath, the 3 day post-CABG patient, the post-colectomy whose surgeon wants him watched closely, the post-carotid stent, the GI bleeder who is no longer bleeding, etc. I would refer you to this notice which states "the presence in an ICU or the use of a ventilator is not sufficient to bill critical care services."
http://www.ucdmc.ucdavis.edu/compliance/pdf/ccare.pdf

All care in ICU is NOT CC

Like signaturedoc said, it is NOT correct to bill all ICU patients as critical care. And as stated above, only SOME familt discussions may count as critical care (though the rules stated in the CPT book are a little different than Medicare's in that respect.

What appears below are Medicare's rules quoted from Ch. 12 of their online Claims Processing Manual.

Seth Canterbury, CPC, ACS-EM

_______

Critical care is usually, but not always, given in a critical care area such as a coronary care unit, intensive care unit, respiratory care unit, or the emergency department. However, payment may be made for critical care services provided in any location as long as the care provided meets the definition of critical care.

Critical care services must be medically necessary and reasonable. Services provided that do not meet critical care services or services provided for a patient who is not critically ill or injured in accordance with the above definitions and criteria but who happens to be in a critical care, intensive care, or other specialized care unit should be reported using another appropriate E/M code (e.g., subsequent hospital care, CPT codes 99231 - 99233).

Examples of patients who may not satisfy Medicare medical necessity criteria, or do not meet critical care criteria or who do not have a critical care illness or injury and therefore not eligible for critical care payment:
1. Patients admitted to a critical care unit because no other hospital beds were available;
2. Patients admitted to a critical care unit for close nursing observation and/or frequent monitoring of vital signs (e.g., drug toxicity or overdose); and
3. Patients admitted to a critical care unit because hospital rules require certain treatments (e.g., insulin infusions) to be administered in the critical care unit.

Critical care CPT codes 99291 and 99292 include pre and post service work. Routine daily updates or reports to family members and or surrogates are considered part of this service. However, time involved with family members or other surrogate decision makers, whether to obtain a history or to discuss treatment options (as described in CPT), may be counted toward critical care time when these specific criteria are met:
a) The patient is unable or incompetent to participate in giving a history and/or making treatment decisions, and
b) The discussion is necessary for determining treatment decisions.

For family discussions, the physician should document:
a. The patient is unable or incompetent to participate in giving history and/or making treatment decisions
b. The necessity to have the discussion (e.g., "no other source was available to obtain a history" or "because the patient was deteriorating so rapidly I needed to immediately discuss treatment options with the family",
c. Medically necessary treatment decisions for which the discussion was needed, and
d. A summary in the medical record that supports the medical necessity of the discussion

All other family discussions, no matter how lengthy, may not be additionally counted towards critical care. Telephone calls to family members and or surrogate decision-makers may be counted towards critical care time, but only if they meet the same criteria as described in the aforementioned paragraph.

Critical care

Meetings with family are not separately billed unless the patient is unable to furnish information pertinent to the treatment plan formulation needed by the treating physician before a plan of action is taken. In other words he needs the information to make his medical decisions on treatment and the patient is impaired (ex, in a coma).