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

The Author is a Professional Medical Practice Billing & Coding Consultant. She has ext

Critical Care

Critical care is what you need when you are dying. If you have ever been waiting in the emergency room, then you have probably seen other people get in before you that needed critical care. Their lives are being threatened, and without the critical care, they would die. That is why they get to see the doctor first.

If you are at risk to need critical care at any given moment, it can help if you live close to somewhere that can provide it. There are many people who live hours away from any medical center. They have grown up using home remedies to cure ailments. Well, home remedies are great, but sometimes it can help to have a trained professional help you during a critical hour.

It is still dangerous to give birth to a baby. Still, most mothers survive giving birth in a hospital. This is just one example of how medical science is better than home remedies in serious circumstances. Now, when the situation isn’t that serious, then I am all for the home remedy. I think it is far better for people to be cured without having to pay a lot for it.

Let’s change gears for a moment. In today’s day and age, people are absolutely thrilled by the excitement of critical care. The shows on television that deal with critical care usually receive very high ratings. People love to watch these shows.

What is it about critical care that is so exciting? What is it about doctors that attract people so much? Why do we love to watch these shows, but when it comes time to be treated, we get so scared?

It’s easy to trust a doctor before you actually have to use one. They are a stranger. They aren’t the doctor you have seen on the television each week. They are someone strange that you have never met before. When you need this type of care, you want someone you know to give it to you. Well, chances are that isn’t going to happen. Doctors don’t usually treat people they know because they’ll care too much to think straight.

I bring this all up to show how upside down the world is. If you need critical care then you should get it. You shouldn’t worry about how the doctors are different than the ones on the television. You shouldn’t worry about your home remedies being sacrificed. You should respect the fact that you are in a dangerous situation, and you need the best help.

Critical care is a very serious thing. It shouldn’t be dealt with lightly. People in a hospital realize this. They give the best care they can.

I hope that this article will help you realize how important it is to receive professional treatment when you are in need of critical care. When you are very sick, it isn’t time to guess at what to do. You need to have a plan, and your plan should be the hospital. That is where you have the best chance at living.