title: Physician reimbursement for critical care services integrating palliative care for patients who are critically ill.
abstract: Patients with advanced illness often spend time in an ICU, while nearly one-third of patients with advanced cancer who receive Medicare die in hospitals, often with failed ICU care. For most, death occurs following the withdrawal or withholding of life-sustaining treatments. The integration of palliative care is essential for high-quality critical care. Although palliative care specialists are becoming increasingly available, intensivists and other physicians are also expected to provide basic palliative care, including symptom treatment and communication about goals of care. Patients who are critically ill are often unable to make decisions about their care. In these situations, physicians must meet with family members or other surrogates to determine appropriate medical treatments. These meetings require clinical expertise to ensure that patient values are explored for medical decision making about therapeutic options, including palliative care. Meetings with families take time. Issues related to the disease process, prognosis, and treatment plan are complex, and decisions about the use or limitation of intensive care therapies have life-or-death implications. Inadequate reimbursement for physician services may be a barrier to the optimal delivery of high-quality palliative care, including effective communication. Appropriate documentation of time spent integrating palliative and critical care for patients who are critically ill can be consistent with the Current Procedural Terminology codes (99291 and 99292) for critical care services. The purpose of this article is to help intensivists and other providers understand the circumstances in which integration of palliative and critical care meets the definition of critical care services for billing purposes.
authors.affiliation: Division of Palliative Medicine, North Shore University Hospital, Manhasset, NY. Electronic address: Lustbader@nshs.edu.
authors.forename: Dana R
authors.initials: DR
authors.lastname: Lustbader
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, NY.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Nelson
authors.affiliation: Department of Internal Medicine, Medical College of Wisconsin Milwaukee, WI.
authors.forename: David E
authors.initials: DE
authors.lastname: Weissman
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, Seattle, WA.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Hays
authors.affiliation: Division of Critical Care and Palliative Care, University of Medicine and Dentistry, Newark, NJ.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Mosenthal
authors.affiliation: Department of Palliative Medicine, Hartford Hospital, Hartford, CT.
authors.forename: Colleen
authors.initials: C
authors.lastname: Mulkerin
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Puntillo
authors.affiliation: Critical Care Department, Lehigh Valley Health Network, Allentown, PA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ray
authors.affiliation: St. Luke's Hospital, Boise, ID.
authors.forename: Rick
authors.initials: R
authors.lastname: Bassett
authors.affiliation: Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Boss
authors.affiliation: Department of Surgery, Froedtert Hospital, Milwaukee, WI.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.affiliation: Department of Nursing, Detroit Receiving Hospital, Detroit, MI.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Campbell
authors.affiliation: Department of Palliative Care, Veterans Integrated Service Network 3, New York, NY.
authors.forename: Therese B
authors.initials: TB
authors.lastname: Cortez
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D001601:Bereavement; D059019:Clinical Coding / Q000592:standards; D003422:Critical Care / Q000191:economics*; D016638:Critical Illness / Q000191:economics*; D003657:Decision Making; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007357:Insurance, Physician Services / Q000191:economics*; D006278:Medicare / Q000191:economics*; D010166:Palliative Care / Q000191:economics*; D011787:Quality of Health Care; D014481:United States