SCCM Resource Library-Good Documentation Is the Key Driver When Reporting Critical Care Services

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The importance of documentation in billing critical care services is emphasized in the text, as it directly supports the medical necessity required by insurance carriers, including Medicare. Critical care documentation should include the reason for the patient's critical status, a detailed history, a comprehensive examination, and a defined plan of care. Essential actions that must be captured are IV replacements, ventilator adjustments, medication alterations, multidisciplinary team discussions, tests conducted, and procedures performed. It is vital to document time spent on critical care since billing codes 99291-99292 are time-based. <br /><br />Teaching time cannot be billed as critical care unless the teaching physician is present. The document should indicate time spent by the teaching physician and confirm that the service was medically necessary. Split/shared visits, newly allowed from January 1, 2022, through Medicare, enable physicians and advanced practice providers in the same group to share billing, with the provider who contributes the most substantial time reporting the service using the FS modifier.<br /><br />Documentation nuances include ensuring the time is allotted if the provider's contribution is unrelated to surgical procedures (using modifier FT). The guidance underscores the necessity of comprehensive documentation to defend critical care billing during payer reviews, as emphasized by the Office of Inspector General Work Plan. Such meticulous records substantiate medical necessity and the efforts taken to manage patient care in critical situations.<br /><br />Lastly, the article references guidelines like the Medicare Claims Processing Manual to ensure adherence to the standards necessary for billing. Deborah Grider, a senior consultant, advocates for precise documentation to substantiate the services and protect against audits or payer scrutiny.

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Administration, 2022, 0:06:38

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This article was first published in the Summer 2022 issue of Critical Connections.

Documentation is important when billing critical care services. Why? Insurance carriers, including government payers such as Medicare, require good documentation to support medical necessity for critical care. Documentation must support the medical necessity of the critical care service.

Critical Connections, the critical care industry's only magazine, provides information in cutting-edge topics in critical care useful to the entire multiprofessional team.

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Meta Tag

Content Type Article

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Economics

Year 2022

Keywords

critical care services

documentation

medical necessity

billing codes

Medicare

teaching physician

split/shared visits

modifier FS

payer reviews

Medicare Claims Processing Manual

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