Critical Care and Neonatal Intensive Care Billing

Topic outline

• Welcome!
  

  Welcome!

  
  

  
  

  
  

  Welcome to the critical care and intensive care billing guide for the division of hospital medicine.

  
  

  If you are trying to decide whether you are providing critical or intensive care for your patient, the sections below describe basic age / weight / time criteria for each code. Beneath each code is a PDF billing guide to the clinical and documentation requirements.

  
  

  If you know which code to use, but are uncertain how to document, you should know that there are standard autotexts in KIDS available for you to use. If you would like to create your own, you may use the CC-IC autotexts document, or any of the billing guides, as a reference.

  
  

  Prior to billing for critical or intensive care, please update your patient's problem list to reflect the highest specificity and acuity of diagnosis appropriate for the patient.

  
  

  The autotexts and billing guides have been vetted and approved by CHLAMG. If you have feedback, please contact Grant Christman at gchristman@chla.usc.edu.

  • Billing Program Announcements Forum
  • Billing Questions Forum

    Use this forum to ask any questions you may have about critical care billing. A member of the billing team will reply as soon as possible. Please avoid sharing any patient-specific information. Thanks!

  • Critical Care / Intensive Care Autotext File
  • DHM Critical Care Billing Introduction 8.22.19 File
  • Critical Care Billing Scenarios 10-12-21 File
  • How to Update the Problem List File
  • CC Diagnoses and Interventions by Service / Subspecialty File
  • Ideal Billing Process

    
    

    
    

• Choosing the Right Bill
  

  Choosing the Right Bill

  • Initial Visit Algorithm

    
    

    
    

    
    

    Subsequent Visit Algorithm

    
    

    
    

    
    

    Cross-cover Algorithm

    
    

    
    

    
    

• Per Diem Critical Care
  

  Per Diem Critical Care

  • Critically ill child ages 29 days - 5 years, primary provider.

    
    

    Autotext for attending note assessment/plan: .dhmcc
    Autotext for attending addendum to resident note: .dhmccattest

    Note: autotexts are case sensitive
    

  • Per Diem Critical Care Billing Guide File
• Time-Based Critical Care
  

  Time-Based Critical Care

  • Critically ill child, ages 6 years or older (primary provider) or any age (secondary provider)

    
    

    Autotext for attending note assessment/plan: .dhmcc
    Autotext for attending addendum to resident note: .dhmccattest

    Note: autotexts are case sensitive
    

  • Time-based Critical Care Billing Guide File
• Neonatal Intensive Care
  

  Neonatal Intensive Care

  • Acutely (not critically) ill neonate/infant.

    Initial: Neonate 28 days or younger, any weight
    Subsequent: Infant 5000 gm or less in weight, any age

    
    

    Autotext for attending note assessment/plan: .dhmnic
    Autotext for attending addendum to resident note: .dhmnicattest

    Note: autotexts are case sensitive

  • Neonatal Intensive Care Billing Guide File
• Standard E&M Billing and Documentation Changes: January 2023
  

  Standard E&M Billing and Documentation Changes: January 2023

  • Time- and Medical-Decisionmaking-Based Billing Overview

    
    

  • Division Meeting Presentation 11-10-22 File

    This is the slide deck from the division meeting presentation given by Meg Grimaldi, Joyce Sakai, and Grant Christman.

  • CHLA Compliance Sharepoint URL

    The CHLA Medical Group Sharepoint site houses resources including updated badge buddies, E&M cards, and past Compliance Counts newsletters.

  • Hospital Medicine CPT 2023 11.10.22 DRAFT File
  • Billing Scenarios 9-6-23 File
• Thank you!
  

  Thank you!

  • We would like to acknowledge the work of Dr. Joshi-Patel, Hess, Lo, O'Callaghan, and Parikh of Texas Children's Hospital and Seattle Children's Hospital, which informed the creation of this guide.

    We would also like to acknowledge the support and assistance of Meg Grimaldi and Joyce Sakai of CHLA Medical Group.