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Critical Care

  • 1.  Critical Care

    Posted 01-15-2020 08:35
    • Good morning

      I am reaching out to ask if any other MFM practice delivers critical care to patients who present on their Labor and Delivery floor? We are gathering data to create OB specific critical care guidelines for billing. Unfortunately so much is Medicare and they do not state OB specific conditions. So far we have DKA, Eclampsia, Sepsi, and Hemorrhage. As well as Medicare listed conditions. 

    I thank you for your time and guidance!

    Monica Dowdell

  • 2.  RE: Critical Care

    Posted 01-17-2020 05:30
    Hi Monica
    Your list sounds very reasonable.  We do NOT bill critical care codes for patients on L&D or our High Risk Pregnancy Unit personally in my practice.  The Coding Committee also has preferred that critical care codes be limited to use in ICU's (designated medical units that are intensive care), or in general by an intensivisit (or double boarded MFM/critical care).  We typically recommend you use E/M when you are consulted for these complex cases, adding prolonged service time is necessary.  We have addressed this issue with coding question #1674 in the past - copied here. Perhaps other MFMs will chime in for you I am sure there are a number of ways to bill in these scenarios as well.  Thanks!

    Coding Q&A: Question #1674

    Is it appropriate to use critical care codes on the labor unit when managing acute, critical illnesses, such as hypertensive crisis or postpartum hemorrhage? Thank you.


    Billing for critical care services (99291/99292) during labor is appropriate only if certain criteria are met.  These criteria include:<o:p></o:p>

    • Clear documentation of a minimum of 30 minutes of critical care services.<o:p></o:p>
    • Clear documentation of the critical care services provided, which includes high complexity medical decision making around the assessment, manipulation, and support of vital system function(s).  The management of most obstetrical emergencies would not be included.<o:p></o:p>
    • Critical care codes are not being billed by any other provider.<o:p></o:p>

     The services provided in the management of most common obstetrical emergencies on the labor floor are not usually critical care services per se, even when they lead to the decision for emergency operative delivery. There are several procedural services that are included as part of critical care services.  For a complete list and additional information on the reporting of critical care services, see the instructions in the CPT code book immediately preceding CPT codes 99291 and 99292.  For extended E&M services not meeting the critical care services criteria, prolonged services codes may be used if the respective requirements are met.

    Vanita Jain