User talk:YONGHWAN KWON/sandbox

Reimbursement

YONGHWAN KWON (talk) 03:59, 26 October 2015 (UTC) The current procedural terminology (CPT) codes most frequently used by ACNPs are subsequent hospital visit codes (99231, 99232, and 99233) and critical care codes (99291 and 99292). The 3 main criteria for the critical care codes are (1) the condition of the patient, (2) the treatment criteria, and (3) time. The important concept in this case is that the intensity of the care of the patient determines the use of these codes, not where the patient is physically located. The CMS published Transmittal 1548 in 2008, which addressed and tried to clarify questions about CPT codes 99291 and 99292. The transmittal states that “critical illness or injury 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.” Documentation of ACNP or physician services should convey this life-threatening deterioration of an organ system (e.g., hemodynamic instability or worsening hypoxic respiratory failure) as well as the interventions to prevent further deterioration of the patient’s condition. To maintain stability of the patient’s condition, “critical care services involve high complexity decision-making to assess, manipulate and support vital system function(s)” and demand the full attention of the provider. Critical care codes are one of the few CPT codes that are time dependent. These codes must have total time spent caring for a single patient clearly stated in the provider’s note. The CMS states: “A qualified NPP may perform critical care services within the scope of practice and licensure requirements for the NPP in the state where he/she practices.” Time for critical care services must be performed at the bedside or on the unit. The first critical care CPT code, 99291, is used when caring for critically ill or injured patients in the first 30 to 74 minutes. It can be used only once in a calendar day. The CPT code 99292 is used for each additional 30 minutes of care performed after the first 74 minutes. Time for face-to-face discussions with the patient and/or family (if the patient is not able to participate) can be included in the time for critical care services if the discussion is related to a specific treatment, such as the need for dialysis, and the justification for the treatment is documented. Phone conversations can also be included in time calculation if the above face-to-face criteria are also met. Regular daily updates on the patient’s condition and plan for care cannot be included in time calculation.