PDFWAC 182-531-0450
Critical care—Physician-related services.
(1) The department reimburses the following physicians for critical care services:
(a) The attending physician who assumes responsibility for the care of a client during a life-threatening episode;
(b) More than one physician if the services provided involve multiple organ systems; or
(c) Only one physician for services provided in the emergency room.
(2) The department reimburses preoperative and postoperative critical care in addition to a global surgical package when all the following apply:
(a) The client is critically ill and the physician is engaged in work directly related to the individual client's care, whether that time is spent at the immediate bedside or elsewhere on the floor;
(b) The critical injury or illness acutely impairs one or more vital organ systems such that the client's survival is jeopardized;
(c) The critical care is unrelated to the specific anatomic injury or general surgical procedure performed; and
(d) The provider uses any necessary, appropriate modifier when billing the department.
(3) The department limits payment for critical care services to a maximum of three hours per day, per client.
(4) The department does not pay separately for certain services performed during a critical care period when the services are provided on a per hour basis. These services include, but are not limited to, the following:
(a) Analysis of information data stored in computers (e.g., ECG, blood pressure, hematologic data);
(b) Blood draw for a specimen;
(c) Blood gases;
(d) Cardiac output measurement;
(e) Chest X-rays;
(f) Gastric intubation;
(g) Pulse oximetry;
(h) Temporary transcutaneous pacing;
(i) Vascular access procedures; and
(j) Ventilator management.