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Re: Critical Care

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  • professor_albus_dumbledore
    Barbara: After attempting to use CodeCorrect to locate references in the Federal Register to the term critical, I find that the November 1, 2001 issue of the
    Message 1 of 49 , Feb 1, 2002
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      Barbara:

      After attempting to use CodeCorrect to locate references in the
      Federal Register to the term "critical," I find that the November 1,
      2001 issue of the FR was indeed located by CodeCorrect--even
      though "critcal" did not appear in the Title of the FR article--only
      in the body of the text.

      So now I'm confused and I don't know why you might not have found the
      November 1, 2001 issue containing the possible crital care code
      changes we've been discussing when you performed your original search.

      Greg Schnitzer
      GSchnitzer@...

      --- In CRN-L@y..., "professor_albus_dumbledore" <GSchnitzer@c...>
      wrote:
      > Well, as my post indicated, you *did* have the right month--
      > November. The Proposed Rule indicating CMS' intent to change
      > critical care reimbursement (the first half of my post) was from
      June
      > 8th; the Final Rule indicating CMS' intent to study the matter
      > further (the second half of my post) was from November 1st.
      >
      > When searching the Federal Register via CodeCorrect, I believe the
      > search function, instead of searching the *entire* text of the
      > document, actually does a search of only the *title* of the various
      > Federal Register articles. If that's indeed the case, perhaps
      that's
      > why you didn't find the citation--you'd need to know the title (or
      > key words in the title) of the article in order to find your
      > information.
      >
      > Greg Schnitzer
      > CodeRyte@c...
      >
      > --- In CRN-L@y..., b.cobuzzi@a... wrote:
      > > Count on Greg Schnitzer to lay his hands on it even if
      > > it happened in June and we were pointing to December.
      > > Thanks Greg!!
      > >
      > > --
      > > Barbara
      > > <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
      > > <<<<<<<<<<<<<<<<<<
      > >
      > > Barbara J. Cobuzzi, CPC, CPC-H,
      > > CHBME
      > > President, Cash Flow Solutions, Inc
      > > Lakewood, NJ
      > > http://www.cfs-billing.com
      > > Senior Vice President, CRN-INC
      > > Coding and Reimbursement Network
      > > can be found at:
      > > http://www.CRN-Web.net
      > > emailto:b.cobuzzi@a...
      > > Voice:(732) 364-0123 Fax: (732)
      > > 364-9111
      > >
      > >
      > > >
      > > > From the June 8, 2001 *Federal Register* Proposed Rule:
      > > >
      > > > 1. Critical Care Services in a Global
      > > > Period
      > > >
      > > > Validation of RUC recommendations
      > > > for the work of many surgical
      > > > procedures included the use of a
      > > > ¡¥¡¥building-block¡¦¡¦ methodology as
      > > > previously described. Before this 5-year
      > > > review, the RUC compared the work of
      > > > a postoperative intensive care unit visit
      > > > by the surgeon to a level three
      > > > subsequent hospital visit (code 99233)
      > > > which is valued at 1.51 work RVUs.
      > > > Now, for the first time since the
      > > > inception of the physician fee schedule,
      > > > one of the ¡¥¡¥building blocks¡¦¡¦ the RUC
      > > > used to validate postoperative work by
      > > > the surgeon in the intensive care unit is
      > > > code 99291 (Critical care, evaluation
      > > > and management of the critically ill or
      > > > critically injured patient, first 30¡V74
      > > > minutes), which is valued at 4.00 work
      > > > RVUs. Specifically, the RUC validated
      > > > the postoperative work of several
      > > > thoracic, vascular, and general surgical
      > > > procedures by comparing the surgeon¡¦s
      > > > intensive care unit visits to code 99291.
      > > > Current Medicare policy allows
      > > > separate payment to the surgeon for
      > > > postoperative critical care services
      > > > during the surgical global period only
      > > > when the patient has suffered trauma or
      > > > burns. If the surgeon provides critical
      > > > care services during the global period,
      > > > for reasons unrelated to the surgery, that
      > > > is separately payable as well.
      > > > The RUC recommendations have
      > > > raised several issues for which we are
      > > > considering future action. In view of our
      > > > desire to ensure that Medicare
      > > > beneficiaries have appropriate access to
      > > > critical care services, and to ensure that
      > > > we make appropriate payments to
      > > > physicians furnishing postoperative
      > > > critical care services to Medicare
      > > > beneficiaries, we are soliciting
      > > > information and comments on the
      > > > following questions and issues:
      > > > 1. If critical care (as described in CPT
      > > > 2001) is provided postoperative, who
      > > > typically provides this care? The
      > > > surgeon, an intensivist, other
      > > > physicians?
      > > > 2. Do surgeons typically meet the CPT
      > > > requirements for billing critical care
      > > > services (as described in CPT 2001)
      > > > when making intensive care unit visits
      > > > on their postoperative patients?
      > > > 3. Are surgeons currently performing
      > > > more, or less, critical care on their
      > > > postoperative patients than they were at
      > > > the time of the last 5-year review?
      > > > 4. What is, or will be, the effect of
      > > > ¡¥¡¥closed¡¦¡¦ intensive care units (a unit
      > > > staffed by dedicated intensivists who
      > > > manage the care for all patients in the
      > > > intensive care unit) on who performs
      > > > postoperative critical care services?
      > > > 5. What is the likelihood of making
      > > > duplicate payment for critical care
      > > > services if the surgical global period is
      > > > valued with the inclusion of critical care
      > > > in the postoperative work (for example,
      > > > if we also pay an intensivist for
      > > > postoperative critical care services)?
      > > > 6. If valuation of the surgical global
      > > > period includes postoperative critical
      > > > care, are there concerns about additional
      > > > carrier scrutiny being applied to claims
      > > > from intensivists for postoperative
      > > > critical care services?
      > > > 7. Does valuation of the surgical
      > > > global period with the inclusion of
      > > > postoperative critical care create an
      > > > incentive for the surgeon to either (a)
      > > > not perform postoperative critical care
      > > > services if there is an intensivist
      > > > available or (b) to not consult an
      > > > intensivist if one is available?
      > > > Below are some of the options we are
      > > > considering:
      > > > „FRemoving work RVUs for critical
      > > > care services from the surgical global
      > > > period, valuing these services as
      > > > subsequent hospital visits and allowing
      > > > surgeons to bill separately for critical
      > > > care (for an identified subset of surgical
      > > > procedures where there is a high
      > > > likelihood that the surgeon is typically
      > > > providing critical care services).
      > > > „FRemoving the work RVUs for
      > > > critical care services from the surgical
      > > > global period, valuing these services as
      > > > subsequent hospital visits and not
      > > > allowing surgeons to bill separately for
      > > > critical care services.
      > > > „FLeaving the work RVUs for critical
      > > > care services in the surgical global
      > > > period, not allowing surgeons to bill
      > > > separately for critical care services,
      > > > requiring surgeons to follow
      > > > documentation rules for critical care
      > > > services and instructing carriers to make
      > > > payment for medically necessary critical
      > > > care services furnished by other
      > > > physicians. (This option would facilitate
      > > > tracking of critical care services, permit
      > > > appropriate medical record review, and
      > > > provide a basis to re-evaluate the work
      > > > of the procedure.)
      > > > Valuing the surgeon¡¦s postoperative
      > > > intensive care unit visits as critical care
      > > > services has raised a number of issues.
      > > > We believe these issues will require a
      > > > change in payment policy to ensure that
      > > > postoperative critical care is
      > > > appropriately paid. Therefore, we are
      > > > proposing to make the work RVUs for
      > > > those surgical codes where any
      > > > postoperative intensive care unit visits
      > > > were valued as critical care, interim,
      > > > until we address the issues discussed
      > > > above.
      > > >
      > > > And from the November 1, 2001 *Federal Register* Final Rule:
      > > >
      > > > 1. Critical Care Services in a Global
      > > > Period
      > > >
      > > > The June 8, 2001 proposed rule
      > > > included a discussion on critical care
      > > > services (66 FR 31067¡V68). We stated
      > > > that current Medicare policy allows
      > > > separate payment to the surgeon for
      > > > postoperative critical care services
      > > > during the surgical global period only
      > > > when the patient has suffered trauma or
      > > > burns. If the surgeon provides critical
      > > > care services during the global period,
      > > > for reasons unrelated to the surgery, that
      > > > is separately payable as well. However,
      > > > the approach the RUC used for the 5-
      > > > year review had previously been used to
      > > > validate postoperative work. That
      > > > approach compared the work of a
      > > > postoperative intensive care unit visit
      > > > by the surgeon to code 99291, Critical
      > > > care, evaluation and management of the
      > > > critically ill or critically injured patient,
      > > > first 30¡V74 minutes, which is valued at
      > > > 4.00 work RVUs, rather than comparing
      > > > a level three subsequent hospital visit
      > > > (code 99233), which is valued at 1.51
      > > > work RVUs).
      > > > We indicated that valuing the
      > > > surgeon¡¦s postoperative intensive care
      > > > unit visits as critical care services had
      > > > raised a number of issues that could
      > > > require a change in payment policy to
      > > > ensure that postoperative critical care is
      > > > appropriately paid. In order to ensure
      > > > that we make appropriate payments to
      > > > physicians furnishing postoperative
      > > > critical care services to Medicare
      > > > beneficiaries, we specifically solicited
      > > > information and comments on several
      > > > questions and issues. We also proposed
      > > > that the work RVUs for those surgical
      > > > codes where any postoperative intensive
      > > > care unit visits were valued as critical
      > > > care remain interim, until we address
      > > > the issues discussed above.
      > > > Many individual physicians, specialty
      > > > societies, and health benefit programs
      > > > provided comments and addressed the
      > > > points we had outlined in the proposed
      > > > notice. We appreciate their responses
      > > > and will carefully review this
      > > > information as we determine whether to
      > > > make a future proposal.
      > > >
      > > > ****************
      > > >
      > > > I hope this helps a bit.
      > > >
      > > > Greg Schnitzer
      > > > GSchnitzer@c...
      > > >
      > > >
      > > >
      > > > --- In CRN-L@y..., "Karen Pyrz" <kpyrz@l...> wrote:
      > > > > Thanks, I probably checked it the same place you did! I,
      too,
      > > > failed to find anything of the nature my doc was referring
      too.
      > > > Thanks for the confirm!
      > > >
      > > >
      > > >
      >
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    • Tara Conklin
      Good Afternoon, Here is my Friday Freak out question of the day. Real basic promise, How many physicians can bill critical care at one time? Even if they are
      Message 49 of 49 , Nov 14, 2003
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        Good Afternoon,
        Here is my Friday Freak out question of the day. Real basic promise,

        How many physicians can bill critical care at one time? Even if they are
        from separate specialties? The answer to this has escaped me and hmmm can't
        quite retreive it

        thanks all, and have a great weekend.

        Tara L Conklin, CPC
        Coding Specialist
        CRN-Institute Instructor
        Clark-Holder Clinic, P.A.
        706-812-4189

        "Courage is not the absence of fear, but rather the judgment that something
        else is more important than fear." - Ambrose Redmoon








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