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Billing and Finance

Next Reply: Re:HELP WITH CLARIFICATION
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Post HELP WITH CLARIFICATION
Author: slmare
Date: Jul 29, 2010 3:05 pm
I just read the post regarding billing critical care codes. We tried utilizing 99291 a couple years ago and was always denied (Medicare). We then went back to utilizing E/M codes (at this time we utilize 99223). After reading the post, I would like to revisit this possibility as our pall med consults do meet the CPT definition for critical care services. If you are utilizing the 99291 (with appropriate ICD-9 codes), are you also adding the V66.7? Has your speciality number been changed to #17? Or does neither one of those matter? We would really like to utilize the critical care code due to reimbursement as the majority of our patients fit this criteria. I do understand we would need to document the time, however we document time spent on all of our visits so this would not be a change for us. Please advise!

Of note, our denial rate at this point is very very low (out of 400 claims, denied 2). We have only been denied payment from Medicare (and this has just started to happen in 2010) is when our patients NOE for hospice was within 24 hours after being seen by our service line (palliative medicine). We have appealed these claims to no avail (our physician in palliative medicine is also the medical director of the hospice program - I don't know if that has any relevance). Regarding the controversy on using the V66.7 on all claims, our medicare carrier advised us to utilize the V66.7 code as our last diagnosis. After reading the posts, it seems like the concensus is the V66.7 does not help. Since our denial rate is so low, I am wondering if it does play a part or am I way off base here? ----- Comments? Opinions?

I thank anyone and everyone in advance for responses...

Replies: order by [Date] [Author] [Subject]
Re:HELP WITH CLARIFICATION (by JulieP on 08/05/2010)
When we have patients that are critical they are typically managed in the ICU by the ICU team. The primary team is usually the one providing critical care; managing respiratory failure, multi system organ failure, etc. Critical care, when appropriate is always billed by the attending team (in the ICU or on the floor). PC may be called in for a consult, however they are not usually managing the critical aspect of the patient's care. While their role is invaluable, it's usually doesn't qualify as critical care. What role are your PC providers playing that if they weren't present would result in the patient's deterioration and possibly even death? That's the question you have to be able to answer; if you can answer it and feel you can substantiate it with the medical records then you should be billing it. IF the ICU team is billing for CC and patinet has respiratory failure and lung cancer and PC is brought in for goals of care, the PC services wouldn't qualify as CC. In our hospital is very unlikely that the PC providers would be rendering CC, although I'm sure it's very possible in other centers.
Julie Pipke-CPC, CAPC Consultant
Re:HELP WITH CLARIFICATION (by kelley08 on 10/07/2010)
I am a ACNS in palliative care program. Our billers and coders have not billed for palliative care before.
Your question is one that we are struggling with now. I spend a lot of time in the critical care area but a lot of my time I do not think is billable.
I have been told we can not bill for family conferences. I have given the information off of CAPC about billing for family conferences but billing/coding does not feel we can bill for that since the pt. is not there.
When we do removal of life support then I am there and do the care and comfort orders and symptom management,would you use the critical care codes for this?
Thank you in advance for any and all help.
Kelley

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