Cpt Medical Coding Guidelines For Critical Care

By Author: Celena Rose
Total Articles: 146
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CPT medical coding or Current Procedural Terminology is the explanation of a procedure or service, identified with a five-digit code and descriptor nomenclature. The five-digit code and the descriptor explain the clinical procedures that were performed by the physician. Frequent changes are quite common in the medical coding industry, and the CPT codes also get modified annually, with changes in CPT being effective from January 1 every year.


Sometimes, medical necessity for a procedure or service is not shown using CPT medical coding. In such cases, an edit would normally create a denial statement for the claim. This goes for critical care where if you report codes inappropriately, the denials will pile up. Make sure you're confident when "critical" cases cross your desk. You must meet all three of the following key criteria to report critical care services:


The patient must meet the definition of critically ill or critically injured - 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.


The physician must perform critical care services - Critical care requires high-complexity decision-making to assess, manipulate and support vital system functions to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient's condition.


Critical care services require a cumulative time of at least 30 minutes on a given date of service - Time can be continuous or intermittent on the date of service and must be clearly documented in the medical record.


The last word for doing proper CPT medical coding is keep yourself up-to-date and keep track of the what's going on around you, so that you do not fall into a scenario which leaves you confused.



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