lvl 4 billing:
HPI: 4 or more
ROS: 10 or more
pmh(includes psh), sh, fh 2 of 3
exam: 8 or more
I spent 35 minutes in direct care of this patient excluding procedures. Critical Care time includes review of prior records, review and interpretation of studies done today, and repeat bedside assessments of the patient’s clinical status. Time also included discussion with the patient and family as to the diagnosis, potential treatments and their risks/benefits, as well as discussion with admitting/consulting physicians in regards to this case.