Billing, collection and practice management for anesthesia and pain management groups.

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Billing, collection and practice management for anesthesia and pain management groups.


COVID-19 Critical Care Time Documentation

Published on May 15, 2020

Although Covid-19 is affecting each anesthesia practice in widely varied levels of severity, in continued response to this rapidly evolving crisis, we at PPM felt that it would be beneficial to provide an outline of the most up to date guidance for billing critical care services and line placement, particularly with regard to time documentation.  The guidelines are lengthy, but they are condensed here into bullet point lists for convenience and ease of use.  


Adult critical care is billed with time-based codes, so it is very important to document the full amount of time spent treating the patient.  This includes:

  • Direct face to face time
  • Coordinating care
  • Reviewing records, test results
  • Documenting care in the record
  • Speaking with family members (provided it is directly related to patient care, not just giving status updates) 


Time can be discontinuous, so all time spent on one patient on one date would be added together and billed in toto, even if it is performed by more than one provider in the practice. 


During the critical care time, the provider’s attention must be focused only on the patient’s care.  A provider cannot provide critical care services to more than one patient at a time.  In other words, the times cannot overlap.  


There are some procedures that are included in critical care, and not separately billable.  They are:


Interpretation of cardiac output measures

  • Chest x-rays
  • Pulse ox
  • Blood gases
  • Interpretation of physiologic data (ECG, blood pressure, hematologic data)
  • Gastric intubation
  • Temporary Transcutaneous pacing
  • Vent Management
  • Some vascular access procedures


Anything not listed above is separately billable*, including but not limited to:

  • Arterial Line
  • Central Line
  • Tracheostomy
  • Bronchoscopy
  • CPR

*NOTE: It is important to document the exact time spent performing these procedures separately from the total critical care time.  This time may not be included in the critical care time for billing purposes.  


By Heather E. Golfos, CPC, CANPC

Coding Department Manager