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