Brain Death

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Posts: 85
Joined: Fri Jun 23, 2017 1:41 pm
Location: Multi-specialty Clinic

Tue Oct 03, 2017 11:43 am

What is the consensus on a visit to determine brain death. Neurosurgeon is billing 99233.

A & P states: On my examination today, pupils remain 7-8 mm nonreactive
Absent corneal, oculocephalic, and ocular vestibular responses
No facial grimacing to deep pain
Absent cough and gag response
No spontaneous respirations
No response to deep pain all extremities
Cerebral blood flow study 8/9/17 reviewed and consistent with brain death
Patient's clinical exam and cerebral blood flow study consistent with brain death.
Discussed with family in the intensive surgical care unit today.

Intensivist has also assessed and determined brain death earlier.
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Thu Oct 12, 2017 8:13 am

This appears to be a neurosurgeon consult, based on the fact that the intensivist has already made a determination of brain death in an earlier assessment.

Given that set of circumstances, all history would need to be gained from another source other than the patient, and the risk is high based on condition. It appears that there will be no follow-up from the neurosurgeon based on the patient’s condition. I think the absolute highest level possible would be 99233, but if this is the full extent of the documentation of the visit, without a time indicator for the family discussion, this looks more like a 99232.

If the physician in question had stated that the blood flow study was directly visualized, rather than “reviewed”, that would be enough to get a 99233. A query process with the physician will more than likely clear up any confusion.

Your question has been answered by J. Paul Spencer, CPC, COC
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