How Do I Bill For Critical Care Services? What is Critical Care Service?

Critical Care is the direct care of the provider rendered to a critically ill or injured patient who requires exclusive attention of the physician. This means a full attention of the physician to the injured or critically ill patient.

Critical Care services will require full personal management by the physician. It is an intervention with life and vital organ systems’ critical condition, life threatening and deterioration. It requires the physician’s full assessment and manipulation to prevent further life threatening deterioration in the patient’s condition.

Critical Care involves High Complexity in Medical Decision Making to assess and manage the life threatening, clinically impaired and injured patient. Vital organs such as but not limited to: central nervous system failure, circulatory system failure, shock, renal, hepatic, metabolic or respiratory system failure.

Critical Care is NOT necessarily rendered in the ICU or CCU. Critical care is always based on the patient’s condition as described above. Therefore, a stable patient in an ICU or CCU is not always a critical care service.

The rendering physician must devote his full attention on the patient and must not be interrupted by seeing other patients.

99291 – Critical Care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292 – each additional 30 minutes (in conjunction with 99291)

The following procedures services are bundled in reporting Critical Care Services and are not billable during the critical care service provided on the same day by the same physician:

1. Interpretation of the Cardiac Output Measurements (93561, 93562)

2. Chest X-rays (71010, 71015, 71020)

3. Pulse Oximetry (94760, in computers ECGs, blood pressure, hematologic data (99090)

4. Gastric Intubation (43752, 91105)

5. Temporary Transcutaneous Pacing (92953)

6. Ventilatory Vascular Access Procedures (3600, 36410, 36415, 36540, 36600)

Medical Necessity Documentation:

Proper documentation must be recorded on the patient’s records and proof of medical necessity why Critical Care Service is rendered.

Illustration on how to bill Critical Care Service:

Less than 30 minutes

Use the appropriate E/M Code

30 min to 1 hr and 14 min (30-74mins) – 99291 (1 unit)

1 hr 15 min to 1 hr 44 min (74-104 mins) – 99291 (1 unit)

+99292 (1 unit)

1 hr 45 min to 2 hr 44 min (105-134 mins) – 99291 (1 unit)

+99292 (2 units)

Modifier 25 and Modifier 24 can be used to bill with Critical Care Services codes (be guided with other procedures which are bundled with Critical Care Services – see above).

For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third party payer payment policies and guidelines

The Author is a Professional Medical Practice Billing

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What Critical Care Specialists Do?

Managing fatal injuries or illnesses is the main objective of critical care medicine. There may be various types of organ support systems needed by patients who are critically injured or ill to survive. In the intensive care unit or the ICU various equipments are fastened to the patient’s body.

People who have specialized in Critical care take care of them. There is 24 hour vigilance over the condition of the patient so as to ensure instantaneous intervention if there is any problem in the patient’s condition. There is a monitor attached to almost all patients which measures the breathing and heart rate of the patient. The staffs get alerted if they hear the beep of the monitor.

It does so only when there is a decrease in the normal range in the patient’s body functions. There may be tubes fastened to the patient’s body in the ICU. These may be inserted into their veins to administer the needed medicines into their body. These are required for the patient to recover. There may be tubes inserted into the nose and stomach of the patient too, which in order to prevent throwing out and gets rid of the gases from the stomach.

If the patient finds it hard to breath, mechanical ventilators are used to facilitate breathing by supplying oxygen to the patient’s lungs. Several problems and disorders like acute respiratory distress syndrome are treated by Critical care professionals. Here the lungs stop functioning abruptly. Infection of the lungs or illness may cause this condition.

Placing the patient in Mechanical ventilator would help the patient retrieve breathing. Trauma is also specialization of these doctors and the staff under them. Motor vehicle accidents and other types of incidents cause serious injuries to thousands of people. Intensive care for life support and further surgery are needed to make these patients survive.

People whose condition are critical and near death are treated by critical care specialists. If these doctors are not there to help they might die. Emergency care units in hospitals employ critical care to bring these patients to normal from the fatal conditions they are pushed into by accidents and illnesses. Intensive vigilance, life support, care of people with lethal diseases are done in the critical care area of the medical field.

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