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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:

  1. 99291
  2. 99292


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