Counting Time for Critical Care Outside the Unit
Question
Can I count my time towards critical care services that I spend talking to the unit when I am at home or in my office? I believe my time is necessary for the care of the patient in the unit.
Answer
CPT and Payers would not consider time where a physician is not immediately available to the patient as critical care services to the patient. This time is considered as pre service and post service work included in any E/M service.
Question
CMS and the AMA posted leniency guidance during the first year (October-1-2015 to September 30, 2016) implementation ICD-10-CM, does this guidance apply to all payers in all settings?
Answer
No, the official CMS/AMA Guidance only applies to Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule. Each commercial payer will have to determine whether it will offer similar audit flexibilities. Additionally, this Guidance does not apply to claims submitted for beneficiaries with Medicaid coverage, either primary or secondary. For more details and ICD-10-CM Q&As regarding the CMS/AMA joint announcement go to https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf
