Documentation is the Key to Getting Reimbursed

There are two major medical billing elements for critical care patients. If these two elements are missing, no or partial reimbursement will be received. In order to collect all the money you are entitled to, your medical billing must be accurate. The two most important elements in medical billing for critical care are time services were rendered and medical necessity requirements.

Let’s face it, during emergency situations documenting times of services rendered on a patient is not the most important factor when dealing with a critical care patient. Patients are quickly moved into the emergency room, are quickly examined and treated as fast as possible.

There are two main critical care evaluation and management codes: 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes), and 99292 (…each additional 30 minutes). Each one of these medical billing codes represents a certain amount of time. The medical billing CPT code 99292 has a significantly higher reimbursement than a 99291. Unfortunately, many physicians fail to record the amount of time during the evaluation, and therefore, force the medical billing staff members to claim a lower CPT. Recording time for critical care patients is very important in medical billing.

The second important factor in critical care medical billing is medical necessity. To be correctly billed, a critical care code must be substantiated; this simply means that you must prove that the patient needed critical care. A critically ill patient in medical billing means that vital organs have been damaged and there is a probability of a life threatening condition or deterioration of the patient’s condition. When sending in the medical billing information, provide documentation that proves that this critical definition has been met and you should see a faster and higher turnaround on your medical billing claims.

View all Articles by: Melissa Clark, CCS-P