I'll save everyone the trouble of looking it up. It's a single sentence.
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//clm1 04c23.pdf <http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm1 04c23.pdf> Top of page 38. A. Definition of Critical Illness or Injury The AMA's CPT has redefined a critical illness or injury as follows: "A critical illness or injury acutely impairs one or more vital organ systems such that the patient's survival is jeopardized." Please note that the term "unstable" is no longer used in the CPT definition to describe critically ill or injured patients. This is my point exactly. Maintain strict compliance with your own documented protocol. If that protocol clearly states that a lactate score is required to guide critical therapy, then it's measure (not its score) is validation of the code. The 'score' would only be applicable (likely even mandatory) for billing additional MD time (99292), MD procedures or justification of patient disposition (DRG/discharge). It's the consistency of these self validating steps that should help improve reimbursements. Sincerely, Matt Reavill [email protected] Plainfield, Illinois From: [email protected] [mailto:[email protected]] On Behalf Of Lori Harmon Sent: Monday, May 14, 2012 10:13 AM To: [email protected] Subject: [Sepsis Groups] posting on behalf of Lawrence Martinelli Colleagues, This post came from: Lawrence Martinelli, MD, FACP, FIDSA Chief Medical Information Officer Medical Director, Case Management/Utilization Review Covenant Health Lubbock, TX There were difficulties with the email so I am sharing the below comments on his behalf. Dr. Martinelli writes: I would be cautious about following the previous advice about billing CPTR 99291 for an ED patient who presents for evaluation and has a normal lactate (<2) and is subsequently dismissed. It may be worthwhile to review the current CPTR Manual for the requirements needed to submit codes for Critical Care (99291, 99292). I would also caution against using vendor-supplied billing and coding advice, as I have seen inaccuracies in some of these documents. If there are questions or concerns, most hospitals have Clinical Documentation departments or Compliance Officers who can advise you.
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