Thyroid Surgery – Frequently Asked Questions and Answers

Thyroid Surgery – Frequently Asked Questions and Answers

Thyroid surgery is a common procedure in which all or a portion of the thyroid gland is removed. Also known as thyroidectomy, this surgical procedure is used to treat several thyroid disorders such as cancer, non-cancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism). The thyroid is a butterfly-shaped endocrine gland located at the base of your neck, intricately placed right on top of the windpipe and next to the food pipe. The thyroid produces hormones that regulate every aspect of your metabolism (right from your heart rate to how quickly you burn your calories). If the thyroid enlarges, it can squeeze these important structures and cause problems with breathing or swallowing. One of the most common reasons for conducting a thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or precancerous. However, benign nodules can also cause problems if they grow large enough to obstruct the throat or if they stimulate the thyroid or overproduce hormones (a condition called hyperthyroidism). Early and accurate diagnosis of thyroid disorders is a difficult task as in most cases the symptoms develop slowly (often over several years). General surgery medical billing and coding is quite complex, as there are several rules related to reporting the procedure accurately. General surgeons or ENT surgeons performing thyroid surgery should correctly document the procedures performed in the patients’ medical records. Medical coding outsourcing is a practical solution for physicians to simplify their documentation process.

Thyroid Surgery

Here are some frequently asked questions and answers about thyroid surgery –

Q: Why is thyroid surgery performed?

A: One of the most common reasons for thyroid surgery is the presence of abnormal growths or nodules (lumps) on the thyroid gland. In most cases, the nodules range in size from several millimeters to centimeters and could be cancerous. Surgery may be recommended for conditions like Goiter (Noncancerous enlargement of the thyroid) and Hyperthyroidism (Overactive thyroid). However, not every patient with thyroid nodules requires surgery. The main decision whether to conduct a surgery or not is taken after careful consideration of the patient’s medical history and the results of the tests done to evaluate the nodules and the functioning of the thyroid gland.

Q: What are the different types of thyroid surgery?

A: There are three different types of thyroid surgery namely – Lobectomy, Subtotal thyroidectomy and Total thyroidectomy.

  • Thyroid lobectomy – one half of the thyroid is removed.
  • Subtotal thyroidectomy – the thyroid gland is removed but a small amount of thyroid tissue is left behind (which preserves some thyroid function).
  • Total thyroidectomy – the entire thyroid gland is removed.

Q: What are the potential risks or complications involved?

A: Generally, thyroidectomy is a safe procedure. However, as with any other procedure, thyroid surgery has its own set of complications –

  • Bleeding
  • Infection
  • Airway obstruction caused by bleeding
  • Permanent hoarse or weak voice due to nerve damage
  • Recurrent laryngeal nerve injury
  • Low blood calcium

Q: Who performs the procedure?

A: In most cases, Thyroidectomy is performed by physicians specialized in otolaryngology, head and neck surgery.

Q: How long will a patient need to stay in the hospital for thyroid surgery?

A: Patients will be admitted to the hospital on the day of the surgery. In most cases, they are able to go home the same day after about 4-8 hours in the recovery room, depending on the extent of incision and timing of the surgery.

Q: What type of anesthesia is given to the patient as part of the surgery?

A: Patients are given either general anesthesia or local anesthesia at the time of the surgery. With both techniques, the surgeon will perform a nerve block so that the neck area is numbed.

Q: How are thyroid problems diagnosed?

A: Thyroid problems don’t develop rapidly. In some cases, the patient’s symptoms may be quite hard to distinguish or may be similar to other disorders. Before performing a surgery, a number of diagnosis and screening tests are conducted to determine the nature and type of thyroid disease. Laboratory analysis of blood determines the amount of active thyroid hormones circulating in the body. A TSH (thyroid stimulating hormone) test is one of the most common blood tests that helps check the thyroid hormones in the blood stream. Sonograms and CT scans may also be conducted to determine the size of the thyroid gland and location of abnormalities. In addition, a needle biopsy of the abnormality or aspiration of fluid from the thyroid gland may also be performed to determine the diagnosis. If the diagnosis is hyperthyroidism, patients may be asked to consume anti-thyroid medicine before the surgery.

Endocrinologists who provide specialized treatment are reimbursed for the services provided to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services offered by reputable companies can help physicians use the correct codes for their medical billing process.

Q: What are the medical codes used for documenting thyroid surgery?

A: The following ICD-10 codes and CPT codes are relevant with regard to thyroid surgery –

ICD – 10 Codes

  • E89.0 – Postprocedural hypothyroidism

CPT Codes

  • 60500 – Parathyroidectomy or exploration of parathyroid(s)
  • 60502 – Parathyroidectomy or exploration of parathyroid(s); re-exploration
  • 60505 – Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach
  • 60212 – Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
  • 60225 – Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
  • 60240 – Thyroidectomy, total or complete
  • 60252 – Thyroidectomy, total or subtotal for malignancy; with limited neck dissection
  • 60254 – Thyroidectomy, total or subtotal for malignancy; with radical neck dissection
  • 60260 – Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid
  • 60270 – Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach
  • 60271 – Thyroidectomy, including substernal thyroid; cervical approach

Q: How are patients evaluated prior to the surgery?

A: All patients undergoing thyroid surgery will be evaluated pre-operatively by conducting a thorough medical history review and detailed physical exam including cardiopulmonary (heart and lungs) evaluation. An electrocardiogram and a chest x-ray are often recommended for patients above 45 years of age or who are symptomatic from heart disease. In addition, blood tests may also be done to determine if a bleeding disorder is present.

Q: What patient preparations are required for the procedure?

A: Prior to your operation (at least one week before the procedure), patients will be seen by the anesthesiologist for a preoperative check. Patients will be asked questions about all the medications they are consuming and instructions will be given whether to stop or continue these medications prior to the procedure. Some of the most important preparation tips include –

  • Do not eat or drink anything after midnight on the night before surgery. However, patients can consume routine medicines for heart disease, blood pressure, or asthma on the morning of the surgery with a small sip of water.
  • Stop taking aspirin and other blood-thinning products (such as Coumadin, ibuprofen and Plavix) at least 7-10 days before surgery, unless otherwise directed by the physician.

Q: Will patients experience pain after the operation?

A: Patients will experience some pain soon after the surgery, but this can be effectively treated with small doses of pain medications. However, patients may experience conditions such as sore throat, difficulty swallowing, or a hoarse voice, all of which will subside quickly.

Thyroid Surgery – Frequently Asked Questions and Answers

Unlisted Codes – Frequently Asked Questions

  • What are unlisted codes?

    Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) Level II codes describe a procedure or service. On the other hand, unlisted codes are designated for services or procedures that are not otherwise specified, that is, they do not describe a procedure or service. Unlisted codes or “Not otherwise specified” codes allow medical coding companies to help physicians report and track services and procedures that do not have a specific CPT code. Reporting the unlisted code correctly with appropriate documentation allows physicians to bill and receive reimbursement even for a procedure that does not have a specific CPT code. Examples of 2018 unlisted codes in orthopedics are:

    • 27299 Pelvis/hip joint surgery
    • 27599 Leg surgery procedure
    • 27899 Leg/ankle surgery procedure
    • 28899 Foot/toes surgery procedure
    • 29799 Casting/strapping procedure
    • 29999 Arthroscopy of joint

    Correct coding requires that the code reported accurately represents the service provided, and not using a code which actually represents another service.

  • Frequently Asked Questions
  • What are the circumstances in which unlisted codes can be used?

    Physicians should never use a CPT code that does not adequately describe the service provided. If it has no specific CPT code, the service should be reported using the appropriate unlisted procedure or service code and adequately documented in the medical record. With regard to the unlisted procedure code, the American Medical Association (AMA) states: A service or procedure may be provided that is not listed in the most current edition if the CPT codebook. When reporting such a service, the appropriate ‘Unlisted Procedure’ code may be used to indicate the service, identifying it by ‘Special Report’. Unlisted procedure codes should be reported only if there is no existing CPT Category I or Category III code to describe the procedure that the physician wants to report.

  • What are the documentation requirements for unlisted codes?

    When using an unlisted procedure code, the physicians should provide a special report or documentation to describe the service. Payers deny claims billed with unlisted procedure codes without narrative information and/or supporting documentation. Claims should be submitted with the following supporting documentation and details:

    • A clear description of the nature, extent, and need for the procedure or service.
    • The patient’s diagnosis and risk of complications.
    • Whether the procedure was performed independent from other services provided, or if it was performed at the same surgical site or through the same surgical opening.
    • Time, effort, and equipment necessary to provide the service.
    • The number of times the service was provided.
    • What was found during the surgery (e.g., the size and location of the lesions).
    • Any other problems that the patient has and the follow-up care will be provided.
    • For unlisted surgery codes, a reasonably comparable service code/procedure should be provided as well as value in comparable RVU and/or percentage of a reasonably comparable CPT.

    The portion of the report that identifies the test or procedure associated with the unlisted procedure code must be legible and clearly marked. It may be also important to indicate why it cannot be addressed with the standard coded CPT procedures.

    The documentation requirements for different types of unlisted procedures are as follows

    • Surgical procedures: Operative or procedure report providing the nature and extent of the patient condition and detailing the work involved in the procedure
    • Radiology/imaging procedures: imaging report
    • Lab and pathology procedures: Lab or pathology report
    • Medical procedures: office notes and reports
    • Unlisted HCPCS codes: operative or procedure note
    • Clinic notes to support medical necessity

    Common attachments also include published articles and clinical information supporting the efficacy of the procedure, a cover letter and a discharge summary. All attachments should be sent with the original claim based on payer rules.

  • Can multiple unlisted codes be reported?

    If the physician performs two or more procedures on the same anatomic location that require the use of the same unlisted code, the unlisted code should be reported only once to identify the services provided. If two or more procedures that require an unlisted code are performed on different anatomic locations, the unlisted code may be reported for each different anatomic location.

  • Do unlisted codes require modifiers?

    A modifier should not be appended to an unlisted code. As unlisted codes do not describe a specific service, they do not require modifiers. However, unlisted codes for DME, orthotics and prosthetics require the appropriate NU, RR or MS modifier.

  • Is prior authorization necessary for unlisted codes?

    Getting prior authorization from the payer before performing an unlisted procedure is important to get reimbursed for elective cases. The prior authorization request should be submitted on the payer’s form designated for this purpose which will allow the physician to describe the planned procedure in detail and the medical necessity. If the unlisted procedure is performed without prior authorization (such as an urgent operation), a copy of the operative report should be submitted, along with information to support the decision-making process and the medical reasoning for performing the operation.

  • What are the steps involved in billing unlisted codes?
    • Obtain the appropriate billing instructions from the payer (whether electronic submission is accepted or if paper submission is required)
    • Obtain preauthorization
    • Select a procedure and code that is comparable to the unlisted procedure performed. This code should represent a procedure on the same body area.
    • Document the factors which make the unlisted procedure the same work, or more or less difficult than the comparison code
    • Use a percentage to indicate the difference in work between the unlisted procedure and the comparison code.
    • Indicate the normal fee for the comparison CPT code and indicate the fee for the unlisted CPT code based on the percentage of more or less work required and describe this in the documentation

Reporting unlisted CPT codes with appropriate documentation and in accordance with payer rules is critical for reimbursement. Outsourcing medical billing and coding to a reliable service provider can ensure reporting of unlisted CPT codes appropriately as well as follow up with payers if claims are denied.

Thyroid Surgery – Frequently Asked Questions and Answers

Hearing Aid Insurance Verification – Frequently Asked Questions and Answers

Hearing loss is a common problem that occurs gradually as people age (presbycusis). Aging and chronic exposure to loud noises are significant factors that directly contribute to hearing loss. Other causes of hearing loss include damage to the inner ear, excessive build-up of ear wax, ear infection and abnormal bone growths or tumors and ruptured eardrum (tympanic membrane perforation). Treatment for this condition depends on the cause and severity of your hearing loss and includes using hearing aids, removing wax blockage, cochlear implants and other surgical procedures. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), one in five people with a hearing loss actually wear hearing aids. One of the common questions asked by people who purchase new hearing aids is related to its insurance coverage. Since insurance plans differ, hearing aid insurance verification is a challenging task which can be handled efficiently by experienced audiology insurance verification companies. With about 48 million Americans (20% of the adult U.S. population) living with some form of hearing loss, the demand for hearing aids is also on the rise. Let’s discuss some of the frequently asked questions and answers about medical insurance verification and reimbursement for hearing aids –

Hearing Aid Insurance Verification

Q: Will my health insurance cover hearing aids?

A: Medicare does not provide for routine hearing evaluation or for evaluation for the purpose of adjusting hearing aids. They will only pay for a hearing evaluation if your physician provides a referral and determines it to be medically necessary. For instance, if you have suffered hearing loss because of an accident or workplace neglect, Medicare may pay for most or all costs of a hearing aid, provided you are able to prove the same. Medicaid often covers hearing aids, but the coverage may vary from one state to another.

Nearly all private health insurance companies provide basic coverage for a comprehensive hearing evaluation which may essentially include hearing loss evaluation (type and degree of hearing loss), hearing tests and hearing aids. However, the extent of coverage varies greatly between insurance providers and may depend on the type of plan opted. For instance, the Empire Plan has $1,500.00 coverage per ear toward hearing aids, and this renews every four years. Therefore, it is always best to check with your insurance authorization company to find out the extent of coverage areas for your plan.

Q: What types of hearing aids and services are covered, including the criteria for coverage?

A: Coverage is offered for new, non-refurbished, monaural or binaural hearing aids, which include ear molds, ear impressions, batteries, special fittings and replacement parts for eligible clients aged 21 years and older. In addition, the hearing aid must meet the client’s specific hearing needs and be covered for repairs under warranty for a minimum of one year. Services covered are related to hearing aid selection, dispensing, fitting, repairs and checks following dispensing.

Q: What is not covered?

A: Coverage is not offered for hearing aid-related items and services such as the following for clients aged 21 years and older –

  • Tinnitus maskers
  • Group screenings for hearing loss
  • Replacement hearing aid batteries and ear molds
  • FM systems, including computer-aided hearing devices for FM systems
  • Pocket talkers or similar devices
  • Duplicate hearing aid(s) for use as a back-up
  • Replacement hearing aids for items that have been – damaged or destroyed by user misuse, abuse or carelessness, lost or stolen
  • Disposable hearing aids, non-electronic hearing aids, battery chargers

Q: What are the prior-authorization or prior-approval requirements for using hearing aids?

A: Hearing aids for children and adults are approved through the automated electronic dispensing validation System (DVS). A DVS is submitted in real time and checks the service limits on the procedure code requested including – frequency, units and age. If service limits are not exceeded, an immediate authorization number is returned. If service limits are exceeded, a prior approval must be requested.

In most cases, a hearing aid DVS authorization will be granted for an approved period of service of 180 days, and can be cancelled by the provider within 90 days of the authorization date. Prior-approval is required for –

  • Binaural hearing aids for persons aged 21 years and older
  • Special ear fittings
  • Replacement of hearing aids for frequency limits
  • Replacement of one aid when the beneficiary wears two
  • Repairs costing $70 or more

Q: What are the documentation requirements for hearing aids?

A: The documentation requirements for hearing aids will vary and depend on the type of insurer and may include –

  • Physician’s medical clearance stating no contraindication for hearing aid use
  • Psycho-social statement indicating the recipient’s ability to use and care for hearing aids, and indication whether they will be assisted by a care-giver
  • Audiologic recommendations – written recommendation for hearing aids (including manufacturer specifications and follow up plan for determining effectiveness of the hearing aid use)
  • History of previous appliance use – including model, serial number, ear worn, year dispensed, history of repair and status of current hearing aid
  • Audiogram – air and bone thresholds, speech thresholds, word recognition ability scores for both ears
  • If requesting monaural fit – indicate which ear is being fit
  • If requesting binaural fit (or replacement of one aid when the beneficiary wears two), provide supporting documentation to verify recipient’s qualification for binaural use
  • If requesting a repair of hearing aid – make a description of the current condition of hearing aid and indicate what repairs are being done
  • If hearing aid is above 5 years old, clearly indicate the reason for repair rather than replacement

Q: What are the insurance eligibility considerations for patients using hearing aids?

A: The insurance eligibility verification for hearing aids must cover the following points –

  • Patients aged 20 years and younger who are receiving services under any medical assistance program
  • Must have a complete hearing evaluation, including an audiogram, sound field speech audiometry or equivalent testing methods performed under the supervision of supervision of an otolaryngologist or licensed audiologist.
  • A written recommendation by a licensed audiologist, otorhinolaryngologist or otologist for a hearing aid and which should include the results of pure tone and speech (clinical) audiometry conducted in a sound treated room and/or test suite meeting the American National Standard Institute’s specifications.
  • Hearing aids must be dispensed within six months of the date of the recommendation

Q: Who are the eligible providers for hearing aids?

A: Eligible providers include audiologists, hearing aid service providers, otolaryngologists and outpatient hospitals, clinics, and other health care providers who employ audiologists, otolaryngologists and/or hearing instrument dispensers.

Q: What hearing screening services are offered to patients below 21 years of age?

A: Providers offer the following services to patients below 21 years of age –

  • Newborn Hearing Screening – Maternity hospitals and birthing centers must screen newborns for hearing loss before discharge. Those infants who fail these screening tests must be referred for audiological evaluation as soon as possible.
  • Hearing Screening for Children below 21 years – Children below 3 years of age must follow the most recent version of American Academy of Pediatrics’ (AAP) recommendations for Preventive Pediatric Health Care for age-specific intervals at which subjective history and/or routine standardized hearing testing should be performed. If these test findings indicate hearing loss or any other hearing problems should be directly referred to age appropriate hearing testing.

Q: Are hearing aid costs tax-deductible?

A: The Internal Revenue Service (IRS) has listed hearing aids and hearing aid batteries among the medical devices eligible for a tax-deduction. In addition to the cost of the hearing aid, you can deduct for the audiology visits and tests needed to obtain the device.

Insurance verification for hearing aids is extensive. Outsourcing audiology insurance verification services to professional providers could help in this regard ensuring that the patient is fully covered for the prescribed device.

To learn more about Audiology Insurance Verification read our blog on 9 July 2018, Audiology Insurance Verification to Avoid Reimbursement Pitfalls.

Thyroid Surgery – Frequently Asked Questions and Answers

Frequently Asked Questions about Critical Care Services

Frequently Asked Questions about Critical Care ServicesCritical care refers to specialized care of patients whose conditions are life-threatening and who require comprehensive care and constant monitoring by a qualified healthcare professional. There are various aspects to coding these services; in fact it is not only about the coding but also about the rules that go along with critical care. Relying on the services of a reliable medical billing company can help healthcare providers get the task done efficiently. Since there are only two codes for reporting critical care, it would be quite normal to think that reporting this service would be simple or uncomplicated. However, several questions arise when a practitioner starts reporting critical care services. Here are some of the frequently asked questions and answers about critical care services.

Q: What is the CPT definition of critical care service?

A: Critical care service is the direct delivery of medical care to a seriously ill or injured patient. An illness or injury can be termed as critical when it acutely impairs one or more vital organ systems so that there is a high probability of imminent or life-threatening deterioration in the patient’s condition. It involves high-complexity decision-making to assess, manipulate and support vital system functions to treat single or multiple vital organ system failure, or to prevent further life-threatening deterioration of the patient’s condition.

Q: What does the term “critical care must be medically necessary” mean?

A: “Medically necessary” means that the patient needs the medical service because she is critically ill, and her illness or injury can acutely impair one or more vital organ systems so that there is a high probability of imminent or life-threatening deterioration in her condition. According to CMS, critical care must be a service that encompasses both treatment of “vital organ failure” and “prevention of further life-threatening deterioration of the patient’s condition”. Examples of vital organ failure include, but are not limited to, central nervous system failure, circulatory failure, renal, metabolic, shock, hepatic or respiratory failure.

Q: What are the specific areas where CCU services are provided?

A: Generally, critical care services are provided in areas such as the coronary care unit, emergency care unit, respiratory care unit and intensive care unit (ICU).

Q: Which specialists manage critically ill patients?

A: Critically ill patients are managed by specialists such as critical care physicians (intensivists), physical therapists, palliative care specialists, respiratory therapists, mid-level practitioners, nutritionists and pharmacists. These specialists must report their services with the correct diagnostic and procedural codes to receive appropriate reimbursement.

Q: Does a patient who has a potential for further deterioration or one who is on ventilator, but with stable condition qualify for critical care?
A: A patient on ventilator may not be considered critical unless she meets the specific critical care definition (even if she is being managed in the intensive care unit). A patient who has undergone a surgery and is placed in intensive care for constant observation may not come under the definition of critical care, if there isn’t a potential life-threatening deterioration. Therefore, correct understanding of what constitutes critical care services is crucial in reporting the services accurately. Here, physicians can benefit from medical billing services provided by a reliable vendor.

Q: What are the guidelines for critical care documentation?

A: Critical care is a time-based service and the medical billing for these services primarily depends on the total time spent on managing, evaluating and providing quality medical support to the patient. The time does not necessarily need to be continuous, but it cannot include the time not devoted towards patient attention.

Q: What should critical care documentation include?

A: Critical care documentation should include the following –

  • The organ system(s) at risk
  • Course of treatment (plan of care)
  • Critical findings of laboratory tests, imaging, ECG, etc., and their significance
  • Which diagnostic and/or therapeutic interventions were performed
  • Likelihood of life-threatening deterioration without intervention

Typically, a patient who is in a critical stage will have a lot of other comorbid conditions. When coding for these services, it is essential for physicians to code and report the patient’s comorbid conditions or underlying conditions even if they are managing only one specific condition.

Q: How is physician time measured for the purpose of determining the correct critical care code(s)?

A: When a patient is admitted to critical care, the time spent towards the following activities will be considered or documented as critical care time –

  • Time spent for bedside procedures with the patient
  • Time spent on activities related to patient attention and observation (including review of old medical records, physical examination, lab and imaging results and consulting with other physicians)
  • Discussions with the family (involves obtaining history that the patient is unable to give or discussion with the family required because a family member must make appropriate medical decisions for the patient)
  • Time spent for writing or dictating notes in the chart or electronic health record
  • Time spent towards reviewing diagnostic tests and data related to the patient

For all subsequent visits (whether on the same date or different date) the documentation should reflect the critical status of the patient, a physical examination, change in treatment plans and labs or other bedside procedures. The total time spent should be documented for each CCU encounter and the codes billed should reflect the total time spent on the date of service.

Q:  What CPT codes are used for reporting critical care services?

A: Adult critical care is a time-based service and is reported for all patients who are critically ill and above the age of 5 years. On the other hand, if the patient is below 5 years, the neonatal or pediatric critical care codes will be reported. Physicians while billing for CCU services must use the following CPT codes –

  • 99291 – Critical care, evaluation & management, first 30 – 74 minutes
  • 99292 – Critical care, each additional 30 minutes

As per CPT guidelines, if the patient is managed less than 30 minutes in a calendar day, the following codes will be reported –

  • 99232 or 99233 or other appropriate E/M code – less than 30 minutes duration

Q: Which services are bundled into the critical care code (as per CPT guidelines)?

A: There are several services that are often included in “critical care clock” time, but can’t be billed separately. However, the time spent on these services is counted towards total CC time and these include –

  • Gastric intubation – (CPT 43752, 43753, 91105)
  • Ventilator management – (CPT 94002-94004, 94660, 94662)
  • Transcutaneous pacing – (CPT 92953)
  • Pulse oximetry – (CPT 94760, 94761, 94762)
  • Peripheral vascular access procedures – (CPT 36000, 36410, 36415, 36591, 36600)
  • Interpretation of cardiac output measurements – (CPT 93561, 93562)
  • Chest x-rays, professional component – (CPT 71010, 71015, 71020)
  • Blood gases, and information data stored in computers (like ECGs, blood pressures, hematologic data) – (CPT 99090)

Q: Is immediate availability of a practitioner to the patient important to report CCU services?

A: Yes, the healthcare practitioner must be immediately available to the patient to report this service. This service will not give the practitioner the freedom to remain at home and discuss the patient’s condition with another physician in the ICU. Critical care service does not need to be continuous, but can be intermittent and can be provided at various times during the calendar date of the service.

Q: What are the procedures that could be billed separately from critical care?

A: Some of the common procedures that may be reported separately for a seriously ill or injured patient include (but are not limited to) –

  • Temporary transvenous pacemaker (33210)
  • Intraosseous placement (36680)
  • Endotracheal intubation (31500)
  • Electrocardiogram – routine ECG with at least 12 leads; interpretation and report only (93010)
  • Elective electrical cardio version (92960)
  • CPR (92950) (while being performed)
  • Central line placement (36555, 36556)

Q: How can practitioners bill for their critical care service during a specific time period?

A: Even if more than one physician/practitioner is managing a critical patient, only one person can bill for the service during a specific period of time. For instance, if a cardiologist and a pulmonologist are taking care of a patient from 10:00 -11:00 am, only one person can bill for that individual time frame. On the other hand, if the cardiologist is managing the critical portion from 1- 2 pm and the pulmonologist manages his portion of service from 2.30-3.30 pm, both of them can bill for their services as long as they are managing different conditions. Diagnosis lays a crucial role in differentiating that they are managing two separate problems.

Q: What are the services that may not be included in critical care time?

A: Services that may not be included in critical care time include –

  • Updating family members who are not making medical decisions
  • Time spent off the unit not providing care directly related to the patient
  • Teaching time with interns, residents and other providers
  • Researching the patient’s condition
  • Time spent for performing procedures for which a separate charge is made
  • Time spent in typical follow up for all patients
  • Time spent caring for other patients either in the unit or in another area of the hospital
  • For Medicare patients, time spent in caring for complications that are related to a procedure

Coding for critical care services can be challenging. Proper understanding about what meets the medical necessity requirement is crucial when reporting this service. Relying on critical care medical billing and coding services provided by a reputable outsourcing company can help providers avoid claim denials and ensure optimal reimbursement.

Disclaimer: The information provided in the above content has been obtained from various internet resources, and is for informational purposes only. OSI (Outsource Strategies International) cannot guarantee that the information contained in the above FAQ is in every respect accurate, complete, or up-to-date. Payment policies may vary from one payer to another and OSI assumes no responsibility for, and disclaim liability for damages of any kind, arising out of or relating to any use, non-use, interpretation of, or reliance on the information contained in this FAQ.