A Little Something About the Critical Care Unit

Critical caring medicine is used to provide life or organ support to patients who are critically ill or injured and require special monitoring. These patients normally suffer from respiratory or airway compromise, renal failure blood instability, or the effects of many organs failing. Patients who have not been stabilized to the point where they do not require intensive monitoring after a major are also given critical care.

This idea of critical caring has been developed as a crucial area of caring for a patient as medical technology and medicine advances. The critical care units first came after world war two to care for patients that required close monitoring and care. In those days, the patients that were most in need of care were located closest to the nursing station while the others were located further away. As a result, the patients were rotated constantly dependent on the need and the availability of beds.

Critical care nurses deal with the response of humans to life threatening traumas. To become a critical care nurse all that is required is for you to be a registered nurse (RN) and trained, obtaining a critical nursing certification is not a must. However, majority of the employers prefer nurses who have been certified in the field, as these nurses would have the skill and knowledge required for the job. To become certified a nurse must provide care for patients who are critically ill for at least 2 years and then they take the exam.

A critical care nurse is required to work under the nursing supervisor and care for the patients to which he or she has been assigned to. The tasks involves performing treatments, dispensing all medications and maintaining accurate and complete records for each patient. This nurse should be able to identify when a patient in critical care is experiencing complications, and be able to operate the different equipments in the critical care unit. This nurse is also required to help the doctors carry out procedures and treatments which is inclusive of sterile treatments.

It is recommended that each critical nurse be assigned 2 patients at most, however this may not be what happens in some hospitals depending on their staffing number. Hospitals in the United States can have up to 24% of the beds that are available for critical care patients. In this unit special and comprehensive care is provided 24/7. The rooms are built with glass walls to facilitate the constant supervision of the patients. In most cases the unit may have specified visiting time, with the visitors being restricted to family members only, so as to allow the staff to work at their optimum level without the influences from outside, compromising the care given.

Critical care doctors treat conditions that are threatening a patient’s life, organ or limb. This area is a medical specialty because it is necessary to provide instantaneous diagnosis along with managing urgent aspects of the patient’s injury or illness. Doctors in the unit must have a wide field of knowledge inclusive of trauma management, surgical skills, airway and cardiac life-support. The medicines used in critical care, include both general medicines and specialized medicines which are used to diagnose conditions and stabilize the patient.

How Do I Bill For Critical Care Services? What is Critical Care Service?

Critical Care is the direct care of the provider rendered to a critically ill or injured patient who requires exclusive attention of the physician. This means a full attention of the physician to the injured or critically ill patient.

Critical Care services will require full personal management by the physician. It is an intervention with life and vital organ systems’ critical condition, life threatening and deterioration. It requires the physician’s full assessment and manipulation to prevent further life threatening deterioration in the patient’s condition.

Critical Care involves High Complexity in Medical Decision Making to assess and manage the life threatening, clinically impaired and injured patient. Vital organs such as but not limited to: central nervous system failure, circulatory system failure, shock, renal, hepatic, metabolic or respiratory system failure.

Critical Care is NOT necessarily rendered in the ICU or CCU. Critical care is always based on the patient’s condition as described above. Therefore, a stable patient in an ICU or CCU is not always a critical care service.

The rendering physician must devote his full attention on the patient and must not be interrupted by seeing other patients.

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

99292 – each additional 30 minutes (in conjunction with 99291)

The following procedures services are bundled in reporting Critical Care Services and are not billable during the critical care service provided on the same day by the same physician:

1. Interpretation of the Cardiac Output Measurements (93561, 93562)

2. Chest X-rays (71010, 71015, 71020)

3. Pulse Oximetry (94760, in computers ECGs, blood pressure, hematologic data (99090)

4. Gastric Intubation (43752, 91105)

5. Temporary Transcutaneous Pacing (92953)

6. Ventilatory Vascular Access Procedures (3600, 36410, 36415, 36540, 36600)

Medical Necessity Documentation:

Proper documentation must be recorded on the patient’s records and proof of medical necessity why Critical Care Service is rendered.

Illustration on how to bill Critical Care Service:

Less than 30 minutes

Use the appropriate E/M Code

30 min to 1 hr and 14 min (30-74mins) – 99291 (1 unit)

1 hr 15 min to 1 hr 44 min (74-104 mins) – 99291 (1 unit)

+99292 (1 unit)

1 hr 45 min to 2 hr 44 min (105-134 mins) – 99291 (1 unit)

+99292 (2 units)

Modifier 25 and Modifier 24 can be used to bill with Critical Care Services codes (be guided with other procedures which are bundled with Critical Care Services – see above).

For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third party payer payment policies and guidelines