In this two-part series we’ll cover crucial elements related to critical care documentation and coding: 1.) a thorough understanding of the definition of critical care, and 2.) the documentation of critical care services and provider time in the Emergency Department.
Critical care is defined as the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.
According to CMS and other payers, critical care must be medically necessary and reasonable, and is a service that encompasses both treatment of “vital organ failure” and “prevention of further life-threatening deterioration of the patient’s condition.”
Critical care involved high complexity decision making to assess, manipulate and support vital system function(s) to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient’s condition.
Examples that would meet the criteria for critical care include but are not limited to the following:
Circulatory failure
Shock
Renal, hepatic, metabolic, and/or respiratory failure
Another determining factor involves the full attention of the provider. For any given period of time spent providing critical care services, the physician must devote his or her full attention to the patient and, therefore, cannot provide services to any other patient during the same period of time. This time can be spent at the immediate bedside of the patient or elsewhere on the floor of the unit, so long as the physician is immediately available to the patient.