Critical Care Service:
Is a
branch of medicine, Focused on management of life-threatening conditions /
critically ill patient. Critical care is the direct delivery by a physician or
other health care professional for a critically ill patient.
Critical care involves high complexity decision making to treat single or
multiple vital organ system failure and to prevent further life-threatening
deterioration of the patient’s condition.
Examples
of vital organ system failure,
1. Circulatory
failure
2. Nervous
system failure
3. Renal
failure
4. Hepatic
failure
5. Respiratory
failure
Critical care may be provided on multiple days if no
changes occur in the patient’s health condition.
Critical
care is usually given in Critical care unit, or coronary care unit, intensive
care unit, pediatric intensive care unit, respiratory care unit or emergency
department.
Critical care time spent with the individual patient
should be documented in the patient’s medical record.
Critical care time:
1. Physician’s
total time spent engaged in work directly related to the patient’s care
(Immediate bedside or elsewhere on the floor or unit reviewing test results or
imaging studies, discussing the case with other medical staff) are considered
as critical care time.
2. If
the physician spent time with the patient’s family members or surrogate
decision-makers obtaining a medical history or prognosis or treatment
limitations are also considered as Critical care time.
Note: Time spent in
activities that do not directly contribute to the treatment of the patient
should not be reported as critical care time even though if they are performed
in the critical care unit (Eg: participation in other meetings, or telephone
calls to discuss other patients).
Time spent on performing other procedures or services that can be coded
separately should not be included in critical care time.
Included services:
1. Interpretation
of cardiac output measurements (93561, 93562)
2. Chest
x rays (71045, 71046)
3. Pulse
oximetry (94760, 94761, 94762)
4. Blood
gases and information data stored in computers [Eg, ECGs blood pressure,
hematologic data (99090)]
5. Gastric
intubation (43752, 43753)
6. Temporary
transcutaneous pacing (92953)
7. Ventilatory
management (94002-94004, 94660,94662)
8. Vascular
access procedures (36000, 36410, 36415, 36591, 36600)
Note: Facilities may
report the above service separately.
Excluded services:
1. Any
services performed that are not included in the above listing should be
reported separately along with critical care services CPT codes.
Critical
care CPT codes
are time-based codes.
1. CPT
99291 –
First 30 – 74 minutes of critical care service to the critically ill patient
2. CPT
99292 –
each additional 30 min.
Age-based Critical Care codes related to the place of service:
Inpatient
1. Infant
28 days of age or younger, Report CPT 99468, 99469
2. Infant 29 days – 71
months of age, Report CPT 99471 – 99476
Outpatient (Emergency or
Office)
1. For
neonates and pediatric patient up through 71 months of age, report CPT 99291,
99292
Note: If the same
physician provides critical care service for a neonate / pediatric patient in
both outpatient and inpatient settings on the same day, report only the
appropriate neonatal/pediatric critical care code 99468-99472.
Transporting critically ill patient from the facility to
facility or hospital to hospital
1. Older
than 24 months of age, report CPT 99291, 99292
2. Younger
than 24 months of age, report CPT 99466, 99467
Billing Guidelines:
Services
provided to a patient who is in critical care unit but not critically ill,
shouldn’t be coded as critical care services, instead of code appropriate
E&M.
Critical care of less than 30 min on a given date shouldn’t be
coded as critical care services, instead of code appropriate E&M
Critical care services of total time (Not continuous /
continuously) 30 to 74 minutes on a given date should be
reported with CPT 99291.
For an additional 30 minutes of time beyond the first 74
min should be reported with add on code 99292 along with primary procedure CPT
99291.
Eg: For
total CC Time with appropriate critical care codes are given below,
1) Less than 30 min of
critical care service – Code only appropriate E&M codes
2) 30 – 74 min of CC
service – CPT 99291
3) 75 – 104 min of CC
service – CPT 99291, 99292
4) 105 – 134 min of CC
service – 99291, 99292 x 2
5) 135 – 164 min of CC
service – 99291, 99292 x 3
6) 165 – 194 min of CC
service – 99291, 99292 x 4
Critical
care and other E&M services may be provided by the same
physician to the same patient on the same day.
No individual should report the remote real-time interactive video
conference critical care services CPT 0188T, 0189T for the period in
which other physician reports CPT 99291, 99292.