CPT Defines critical care as 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 in such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.
Critical care involves:
- High complexity decision making to assess, manipulate and support vital system function(s);
- Treating single or multiple vital organ system failure; and/or
- Preventing 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
- Renal, hepatic, metabolic and/or respiratory failure
Critical care time is the time spent in work that directly relates to the individual patient’s care, whether that time is spent at the immediate bedside or elsewhere on the floor or unit. Evidence that the above criteria have been met must be present in the medical record, along with the physician’s attestation that critical care was provided.
Although critical care typically requires interpretation of multiple physiologic parameters and/or application of advanced technologies, critical care may be provided in life threatening situations when these elements are not present.
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.
Services for a patient who is not critically ill, but happens to be in a critical care unit, are reported using appropriate E/M codes.
For reporting by professionals, the following services are included in critical care, when performed during the critical period, by the physician(s) providing critical care:
- Interpretation of cardiac output measurements
- Chest X-Rays
- Pulse Oximetry
- Blood Gases
- Informational data stored in computers (ECG, blood pressure, hematologic data)
- Gastric Intubation
- Temporary Transcutaneous Pacing
- Ventilation management
- Vascular access procedures
Any services performed that are NOT included in this listing, should be reported separately.
Critical care codes 99291 and 992992 are used to report the total duration of time spent in the provision of critical care services to a critically ill or critically injured patient, even if the time spent, providing care on that date, is not continuous. For any given period of time spent providing critical care. Time spent with the individual patient should be documented in the patient’s medical record.
CPT 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 of service, even if time spent 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.