| Critical care is
defined as the direct delivery by a physician of medical care for a
critically ill or critically injured patient. Critical illness acutely
impairs one or more vital organ systems such that there is a high
probability of imminent or life threatening deterioration in the
patient’s condition. Critical care requires high complexity medical
decision-making to assess, manipulate and support vital organ
system function in order to treat single or multiple vital organ
system failure.
Examples of organ
system failure include:
1) Central nervous system failure
2) Circulatory failure
3) Shock
4) Acute renal failure
5) Acute hepatic failure
6) Acute metabolic failure
7) Respiratory failure
These services are
based on TIME. The
total time spent in any 24 hour calendar day is added up to come up
with billable critical care time. Time spent on critical care
DOES NOT need to be continuous. The total time billed for
critical care MUST be recorded in the chart. The time spent on critical
care DOES NOT need to be spent in face-to-face care of the patient,
but must be spent in the location where the critical care is being
performed (e.g., in the ICU or
CCU
). For example, time spent on
the unit or at the nursing station reviewing test results or imaging
studies , discussing the patient’s care with other medical staff, or
documenting critical care services would
ALL
be reported as time spent on
critical care, even though it does not occur at the bedside. Also, when the patient is
unable to give information, time spent in the unit with the family
members or surrogate decision-makers obtaining a medical history,
reviewing the patient’s condition or prognosis or discussing
treatment may
ALL
be reported and
billed as critical care time.
Critical care may be
provided on multiple days, even if no changes are made in the
treatment rendered to the patient, provided that the patient’s
condition remains critical.
Critical care DOES
NOT need to be provided solely in an intensive care unit. Critical care and other E/M
services may be provided on the same day by the same physician.
The following
services are INCLUDED in critical care and should not be reported
separately:
1) Cardiac output measurements
2) Chest X-ray interpretation
3) Pulse oximetry
4) ABGs
5) EKG interpretation
6) Gastric intubation
7) Transcutaneous pacing
8) Ventilator management
9) Peripheral venous access
10) Arterial
puncture
Any service not
listed above (for instance placement of a central line) is NOT
included in critical care and should therefore be reported
and billed separately.
The following codes
are used to bill for critical care:
- 99291
- 99292
| This topic is covered in much more detail in of one of our web-based E/M coding courses. |
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Critical Care and Other Timed Services |
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Related Topics |
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| What is critical care? What needs to be documented? What is needed for prolonged services? Using real-life examples, you will get the answers to these questions and more from this course. |
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