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Author: Admin | 2025-04-28
(Moderate Complexity)The coder then looks at facility code levels 99284 and 99285 to determine if any interventions falling within those levels were provided. The coder determines that the highest facility code level achieved by any intervention provided to this patient is intervention at the 99283 level. Thus, the coder assigns facility code 99283 (APC 614) as the appropriate "Facility Code Level". Critical CareFacility code 99291 - APC Level 617The assignment of the Critical Care code 99291 likewise follows the same instructions applicable to the five E&M codes 99281-99285. There is a 30 minute time requirement for facility billing of critical care.The administration and monitoring of IV vasoactive medications (such as adenosine, dopamine, labetolol, metoprolol, nitroglycerin, norepinephrine, sodium nitroprusside, etc) is indicative of critical care.Example:EMS brings in a 68 year old man who is suffering grand mal convulsions, with only brief interludes of from one to three minutes between convulsions. He undergoes a multiplicity of diagnostic tests, receives 2 mg of Ativan IV followed by an IV infusion of one gram of Dilantin over one hour. His blood pressure is 240/140 and he receives an IV infusion of sodium nitroprusside which brings his pressure down to180/110. A C-T scan reveals an acute intracerebral hemorrhage which is fairly small and which has not yet resulted in any mid-line shift of the cerebral hemispheres. He is transferred to another hospital (to the on-call neurosurgeon) for numerous reasons, including the family's wishes and the fact that the only neurosurgeon in town is presently in surgery at the "other hospital". 45 minutes of Critical Care is documented.The coder looks under "Potential Symptoms/Examples" and finds "Status-Asthmaticus, Epilepticus" as well as "Cerebral Hemorrhage of any type" listed under the "Critical Care" section. The coder identifies documentation that the patient received IV drips of Dilantin and sodium nitroprusside and then finds the intervention of "Multiple parenteral medications requiring constant monitoring" under the "Critical Care" guideline. With 45 minutes of Critical Care time documented and since only a single intervention listed under the "Possible Interventions" applicable to "Critical care" is necessary in order to assign facility code 99291, the coder assigns Critical Care code 99291 (APC 617). Definitions for Discharge InstructionsStraightforward: Self-limited condition with no meds or home treatment required, signs and symptoms of wound infection explained, return to ED if problems developSimple: OTC medications or treatment, simple dressing changes; patient demonstrates understanding quickly and easilyModerate: Head injury instructions,
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