Billing and Documentation

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  • 1.  10/12/2022 KEG Call Recording

    Posted 10-12-2022 16:27
    The recording from the Billing and Documentation KEG Call that was held today, 10/12/2022 can now be viewed in the library.

    Claudia Drath
    Components Specialist

  • 2.  RE: 10/12/2022 KEG Call Recording

    Posted 02-06-2024 12:39

    Can we bill Critical Care time discussing goals of care (ACP Note)?
    If so, is there a limit as to how long, or how many times this conversation can be had?
    Finally, does the patient’s code status have to actually change, in order for this conversation to be ‘billable’,….or is it enough that family concerns are being heard and discussed, as long as there is adequate documentation, (but without an actual change in the final code status),…..

  • 3.  RE: 10/12/2022 KEG Call Recording

    Posted 02-06-2024 13:19
    When you have a conversation with the patient and family that involves "critical decision-making" and NOT just an update on the patient's condition, it can be billed as critical care time.  The note should reflect 3 elements: 1) critical decision-making, 2) direct face-to-face preferably, 3) bedside with patient present preferably.  When the patient is incapacitated, it is important to document this fact and that you are speaking with the surrogate-decision-maker/legally authorized representative.  It does not mean that you necessarily have to change any orders/status, but that this critical goals-of-care discussion has taken place, who was present, and what the discussion entailed.


    Cherylee W. J. Chang, MD, FACP, FCCM, FNCS 

    Division Chief, Neurocritical Care 

    Professor, Department of Neurology, Neurosurgery, and Medicine

    Duke University

    40 Medicine Circle 

    Suite 0109, Room 0129 

    Durham, NC 27710 

    Office: (919) 684-8246 


  • 4.  RE: 10/12/2022 KEG Call Recording

    Posted 02-06-2024 13:24


    John V. Agapian, MD, FACS, FCCM

    Sent from my iPhone

  • 5.  RE: 10/12/2022 KEG Call Recording

    Posted 02-06-2024 18:40
    Thanks for asking this. I get a different response every time I ask at my shop��

  • 6.  RE: 10/12/2022 KEG Call Recording

    Posted 02-07-2024 08:49

    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.

    Gregory Kapinos HEC-C, MD, MS, FCCM
    Assistant Professor, Neurosurgery
    Icahn School of Medicine at Mount Sinai
    New York NY

  • 7.  RE: 10/12/2022 KEG Call Recording

    Posted 02-07-2024 09:19

    Dr. Kapinos' comments reflect a deep understanding of the coding environment and I believe are accurate. From a practical standpoint, many find including the type of care that is the focus of this thread within their 9929X time as most efficient. Certainly, with an educational effort, one could bend their practice in the direction of documenting additional codes for services rendered but I am not sure the effort would be viewed as valuable and I have not performed an financial impact analysis on such a change in practice. I would be interested in Dr. Kapinos' thoughts.



    Daniel R. Brown, MD, PhD, FCCM

    Professor of Anesthesiology

    Hospial Medical Director

    Mayo Clinic

    Rochester, MN  USA