CRITICAL CARE SERVICES

CRITICAL CARE SERVICES

           Critical care is the direct delivery by a physician(s) or other qualified health care professional of medical care for a critically ill or critically injured patient.

           A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of  life threatening deterioration in the patient's condition.

           Critical care involves high complexity decision making to assess, manipulate, and support vital system function to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient's condition.

Examples of vital organ system failure include, but are not limited to, central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure.

Although critical care typically requires interpretation of multiple physiologic parameters and/or application of advanced technology(s), critical care may be provided in life threatening situations when these elements are not present.

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 continues to require the level of attention described above.

Providing medical care to a critically ill, injured, or post-operative patient qualifies as a critical care service only if both the illness or injury and the treatment being provided meet the above requirements.

Time spent with the individual patient should be recorded in the patient's record.

CPT 99291- Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

CPT 99292- Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service)

Inpatient critical care services provided to infants 29 days through 71 months of age are reported with pediatric critical care codes 99471- 99476

The pediatric critical care codes are reported as long as the infant/young child qualifies for critical care services during the hospital stay through 71 months of age.

Inpatient critical care services provided to neonates (28 days of age or younger) are reported with the neonatal critical care codes 99468 and 99469.

The neonatal critical care codes are reported as long as the neonate qualifies for critical care services during the hospital stay through the 28th postnatal day.

The reporting of the pediatric and neonatal critical care services is not based on time or the type of unit (eg, pediatric or neonatal critical care unit) and it is not dependent upon the type of physician or other qualified health care professional delivering the care.

To report critical care services provided in the outpatient setting (eg, emergency department or office), for neonates and pediatric patients up through 71 months of age, see the critical care codes 99291, 99292.

 If the same individual provides critical care services for a neonatal or pediatric patient in both the outpatient and inpatient settings on the same day, report only the appropriate neonatal or pediatric critical care code 99468-99472 for all critical care services provided on that day.

Also report 99291-99292 for neonatal or pediatric critical care services provided by the individual providing critical care at one facility but transferring the patient to another facility.

Critical care services provided by a second individual of a different specialty not reporting a per day neonatal or pediatric critical care code can be reported with codes 99291, 99292.

For additional instructions on reporting these services, see the Neonatal and Pediatric Critical Care section and codes 99468-99476. Services for a patient who is not critically ill but happens to be in a critical care unit are reported using other appropriate E/M codes.

            Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is not the only requirement for providing CC services. Presence of a patient in an ICU or use of ventilation is not sufficient to bill a CC service.

The following three criteria must be met for reporting CC service:

            1.       The severity of illness

            2.       The intensity of services required treating the illness, and

            3.       The time spent in providing the care.

Proper documentation showing the medical necessity for providing CC services is an absolute requirement.

Usually a critical care service is provided to a patient in a "critical care area" such as the

        1.       Coronary care unit (CCU),

        2.       Intensive care unit (ICU),

        3.       Respiratory care unit, or

        4.       Emergency room.

This code is applicable for a critical care service provided for first 30 – 74 minutes. Any CC service provided for less than 30 minutes should be billed with the appropriate level of E/M code.

Critical care services require a cumulative time of at least 30 minutes on a given date of service

– Time can be continuous or intermittent on the date of service and must be clearly documented in the medical record.

     The total time can be calculated by the time spent evaluating, managing, and providing critical care services to a critically ill or injured person.

     The time to be billed for CC must be spent at the immediate bedside or elsewhere on the floor as long as the physician is available to the patient. Full attention of a physician must be paid towards the CC service

This code is applicable for patients 25 months of age and older.

Inclusive Services:

The following services are included in "critical care service" time when performed during the critical period by the same physician(s) providing critical care and should not be reported separately:

          1.       The interpretation of cardiac output measurements (93561,93562)

          2.       Pulse oximetry (94760, 94761, 94762)

          3.       Chest x–rays, professional component (71010, 71015, 71020)

          4.       Blood gases, and information data stored in computers (e.g., ECGs, blood pressures, hematologic data–CPT 99090)

          5.       Gastric intubation (43752, 91105)

          6.       Transcutaneous pacing (92953)

          7.       Ventilator management (94002–94004, 94660, 94662)

          8.       Vascular access procedures (36000, 36410, 36415, 36591, 36600)

Code 99291 is used to report the first 30-74 minutes of critical care on a given date. It should be used only once per date even if the time spent by the individual is not continuous on that date. 

Critical care of less than 30 minutes total duration on a given date should be reported with the appropriate E/M code. 

Code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes. 

 

The following examples 

30-74 minutes (30 minutes - 1 hr. 14 min.) 99291 X 1 

75-104 minutes   (1 hr. 15 min. - 1 hr. 44 min.) 99291 & 99292 X 1 

105-134 minutes (1 hr. 45 min. - 2 hr. 14 min.) 99291 & 99292 X 2 

135-164 minutes (2 hr. 15 min. - 2 hr. 44 min.) 99291 & 99292 X 3 

165-194 minutes (2 hr. 45 min. - 3 hr. 14 min.) 99291 & 99292 X 4