Critical Care Medical Billing

Critical care is often confusing in the world of medical billing as a number of factors can come into play and whether you need to bundle services or not will also be an issue. Due to the nature of the critical care - notes are often made hurriedly and in many cases are incomplete and it is up to the medical billing professional to put it all together into a package that will be clear, concise and easy to read for the carrier to the services may be reimbursed.

A good example is if a surgeon performed 64 minutes of critical care for a patient in cardiac arrest. During the encounter, the physician also took a chest x-ray and performed ventilatory management. You need to show the medical necessity for all the procedures performed but in this case should most likely bundle all the services together as one critical care service as CPT guidelines bundle chest x-rays (71010, 71015 and 71020) and ventilatory management (94656, 94657, 94660 and 94662) into (not separately payable with) critical care codes (99291-99292) - so they would not be billed as separate services.

Do however report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the critical care and link it with 427.5 (Cardiac arrest) to 99291 to represent the patient’s cardiac arrest.

Making sure you know when and when not to bundle services will result in better reimbursements for your practice.

Labels: claims, medical-billing, medical-coding, modifiers, outsourcing