Nuwer Marc R, Vespa Paul M
Continuum (Minneap Minn). 2018 Dec;24(6):1800-1809. doi: 10.1212/CON.0000000000000667.
Coding specifies the work performed when providing patient care. Critical care services mostly use code 99291, and other codes specify additional time and procedures. Current Procedural Terminology defines critically ill as "a high probability of imminent or life-threatening deterioration in the patient's condition," a condition necessary for use of the critical care code. A patient may be critically ill for neurologic reasons even when stable from a cardiorespiratory status. Rules govern who can use these codes, whether they can be used by more than one physician, the locations where the code may be used, and what services are included and excluded. Physicians need to document the medical necessity of visits and nature of critical illness or high-risk medical decision making because auditors may not understand the nature of serious neurologic illness.
编码规定了提供患者护理时所执行的工作。重症护理服务大多使用代码99291，其他代码则规定了额外的时间和程序。现行《医疗程序编码术语》将危重症定义为“患者病情即将恶化或有生命危险的高概率情况”，这是使用重症护理代码所必需的条件。即使患者心肺状况稳定，也可能因神经系统原因而处于危重症状态。规则规定了谁可以使用这些代码、是否可以由多名医生使用、可以使用该代码的地点以及包括和排除哪些服务。医生需要记录就诊的医疗必要性以及危重症的性质或高风险医疗决策，因为审计人员可能不了解严重神经系统疾病的性质。
