Billing and Documentation

Yes, for patient's not communicating their values to engage in goals of care setting, which is crucial for appropriate critical care provision, discussions with family members do qualify as part of the critical care time and can thus amount to CPT code 99292s. There is not "limit" as long as you reflect actual time spent with them, usually in a conference room close to the ICU and this clinical work falls as part of the critical care time, akin to time reviewing labs and imaging in the ICU office. Of course, total time spent in 24 hours cannot exceed your actual time spent in your shift in the hospital for all your patients. Repeating a code 99292 every other day when you update family members and make major decisions with critical care interventions that needed clarifications on the goals of care can be appropriately counting towards these CPT codes, without any limit, but it would be bizarre and likely flagged for audit to abuse of it every day for instance. Code status does not need to change to bill 99292. However, again, substantial decisions need to be reflected in these. Also, there are dedicated codes for the ICD-10 and for additional CPT codes that do reflect palliative encounters, decision for end of life measures etc, so choose accordingly and for a few of these separate additional codes, yes, actual goals of care changes would be expected to match the billing. For instance, Documentation of Comfort Measures Only is CPT code 1152F, whereas End of Life Counseling is S0257. The former implies you changed the code status to DNR and goals of care to CMO, whereas the latter only relates to the actual meeting and discussion regardless of the conclusions at the end of the meeting. When you separate decisions on critical care interventions and do not want to use 99292, you may use the dedicated code for a palliative encounter 4350F, usually a scheduled multidisciplinary meeting with a dedicated palliatist or its team representatives.

ICD-10 codes of interest that may be added to all the actual oragn failure diagnoses codes are for instance End of Life Care Z51.50 and Z71.89 for GOC counseling, or other pain or discomfort related "diagnoses".

I hope this helps.