Critical Care CPT Information

Critical Care is the direct delivery by a physician(s) 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 imminent or life threatening deterioration in the patient’s condition. 

The medical record documentation by the physician should easily identify the necessity of constant attendance indicative of critical care time.

Critical care requires:

• The full attention of the physician to that patient
• Medical decision-making of high complexity
• Time spent performing critical care must be directly related to the patient’s care 

Critical care may be continuous or interrupted.  The time spent performing critical care must be documented in order to bill for it.  

Examples of services performed elsewhere that may represent critical care, include:

• Time spent on the unit or at the nursing station on the floor reviewing test results
• Discussing the patient’s care with other medical staff
• Documenting critical care services in the patient’s medical record
• Obtaining medical history and discussing treatment options with family members if:
• The patient is unable or incompetent to participate him/herself in this process
• The discussion is absolutely necessary for treatment decision under consideration that day
• The progress notes reflect the above 2 statements, as well as the treatment decisions for which the discussion was needed and the substance of the discussion

Examples of family discussions that are NOT included in critical care, include:

• Regular periodic updates of the patient’s condition
• Emotional support for the family
• Answering questions regarding the patient’s condition (only questions related to medical decision-making regarding treatment may be counted toward critical care)

Examples of services performed that may NOT be included in the critical care time:

• Activities that occur outside of the unit or off the floor, including phone calls taken anywhere (whether home, office or elsewhere in the hospital)
• Activities that do not directly contribute to the patient’s care, including meetings, and time spent consoling the family
• Performing separately reportable procedures or services 

Services that are included in critical care:

• Interpretation of cardiac output measurements
• Chest x-rays
• Pulse oximetry
• Blood gases
• Information data stored in computers (e.g. ECGs, blood pressures, hematologic data)
• Gastric intubation
• Temporary transcutaneous pacing
• Ventilatory management
• Vascular access

Teaching Physicians and critical care:

• Time spent by a resident may not be added to the total time billed by the attending physician for critical care.  For services to count toward critical care time, the teaching physician must be present the entire time that critical care services are being provided.
• Those services do not include time spent teaching or for education of the resident

Critical care is reported using the following codes:

• 99291-Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 mins.
• 99292- Critical care, evaluation and management of the critically ill or critically  injured patient; each additional 30 mins.