Critical Care

• Critical care is the direct delivery by a physician of medical care for a critically ill or injured patient.
• A critical illness or injury 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.
• Any physician or NPP can bill for critical care.
• Critical care does NOT necessarily have to take place in the intensive care unit.

Coding for Critical Care: Two Time-Based Codes

• 99291                 Used for the first hour                                              Reimbursement: $199.07
• 99292                 Used for each additional 30 minutes             Reimbursement: $100.20

Adding Up Time for Critical Care

• Medicare and the AMA could not agree on how to report critical care time.
• As a result, there are two methodologies for reporting critical care time, one endorsed by the AMA and contained in the CPT manual and one endorsed by Medicare.

This topic is covered in detail in our E/M coding courses, which include additional insight, specific clinical examples and the complete rules for performing and documenting these services in daily practice.