Description: There is a significant variability in education and interpretation of appropriateness of coding and documentation of critical care services. This session will address key recommendations of coding and documentation for all critical care practitioners who participate in the same including physicians, advanced care providers (both NPs and PAs). This session will also cover various aspects of documentation, coding and billing Adult and Pediatric Critical Care Services. Understanding coding and documentation for Critical Care Services is essential for professional coders, hospital administrators, advanced practice providers and physicians. This session will cover coding rules for critical care services for both adults and pediatrics and the importance of supporting documentation to support medical necessity for reimbursement.

At the end of this presentation the participant should have a clear understanding of how documentation plays a significant role in supporting medical necessity for Critical Care services. We will also review split/ shared visits performed by physicians with advanced practice providers and provide examples of critical care services.

Learning Objectives:

1) Recognize how medical necessity is the driving factor in supporting critical care services.

2) Explain split/shared visits in critical care and hospital services with required documentation and modifiers to support the visit.

3) Recognize how documentation impacts reimbursement for critical care visits.

4) Review documentation examples common to critical care services.

Webinar Date: This was presented as part of IHIMA’s 2024 Annual Meeting & Exhibit – April 2024 

Duration: 1 hour

Speaker: Deborah Grider, CDIP, CCS-P, CPC, CPC-I, CPC-P, COC, CPMA, CEMC is a senior consultant with Karen Zupko & Associates and a nationally sought-after leader in the industry. She is passionate about assisting physicians and hospitals in improving their coding, documentation, and business operations to maintain compliance and improve revenue. Deborah holds multiple coding certifications including Certified Professional Medical Auditor and is a certified Clinical Documentation Improvement Practitioner. Deborah brings over thirty-six years of healthcare industry experience as a practice administrator, medical record auditor, clinical documentation improvement practitioner, as well as a sought-after speaker and educator. She has worked with a variety of medical specialties. She works with physicians, hospitals, and outpatient facilities both small and large and provides practice assessments, revenue cycle guidance, coding, auditing, CDI development, education, and project management. She also provides litigation support to attorneys nationally on behalf of their physician and health-system clients. Deborah combines teaching with practical advice on coding and revenue cycle issues to many national organizations. She has numerous books and publishing credits including book publications for the American Medical Association and the Society for Critical Care Medicine She has also developed coding program curriculum for several organizations. She currently serves on the ICD-10 Monitor Editorial Board and Indiana Health Information Management Association Executive Board of Directors as the treasurer. She is the past president of the Indiana Health Information Management Association and the past president of the American Academy of Professional Coders National Advisory Board. Deborah has served on the CPT Editorial panel, the editorial board of Contexo Media. She is the 2017 AHIMA Triumph Literacy Legacy Award Recipient.

Click HERE to register for this webinar!

Cost: $25 Members/ $35 Non-Members

1 AHIMA CEU*

Domain I: Data Structure, Content, and Information Governance

*AHIMA CEUs are also accepted by the AAPC. Check eligibility on the AAPC website.