Critical care is the direct delivery of medical care, by a physician(s), for a critically ill or critically injured patient. CMS defines critically ill and injured patients as those who are experiencing one or more vital organ failure(s) and who have a high probability of life-threatening deterioration in their condition. Critical care requires high complexity medical decision-making to assess, manipulate and support vital organ system function in order to treat single or multiple vital organ system failure.
2. Critical Care
Critical care is the direct delivery of medical care, by a
physician(s), for a critically ill or critically injured
patient. CMS defines critically ill and injured patients as
those who are experiencing one or more vital organ
failure(s) and who have a high probability of life-
threatening deterioration in their condition. Critical
care requires high complexity medical decision-making
to assess, manipulate and support vital organ system
function in order to treat single or multiple vital organ
system failure.
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3. 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 remains critical.
Critical care DOES NOT need to be provided
solely in an intensive care unit. Critical care
and other E/M services may be provided on
the same day by the same physician. Know
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4. The following services are INCLUDED in critical care and
should not be reported separately:
1) Cardiac output measurements
2) Chest X-ray interpretation
3) Pulse oximetry
4) ABGs
5) EKG interpretation
6) Gastric intubation
7) Transcutaneous pacing
8) Ventilator management
9) Peripheral venous access
10) Arterial puncture
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5. The Key Elements of Critical Care
• 1)99291
• 2)99292
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6. 99291: This Code is Used for Critical care,
evaluation, and management of the critically
ill or critically injured patient; first 30-74
minutes. It is to be reported only once per day
per physician or group member of the same
specialty.
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7. 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). This code is
used ONLY in conjunction with the 99291
code. EACH additional thirty minutes beyond the
first hour of critical care is reported using this
code. For example, if you spend 90 minutes on
critical care in one calendar date, the encounter
would be reported by using the 99291 for the
first hour, plus one 99292 code used to report the
additional 30 minutes.
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8. Critical care settings
Large medical facilities usually have intensive
care units (ICU), where critical patients receive
care. Some facilities have multiple units
depending on the circumstances and needs of
the community. ICUs might be located near
the operating rooms for critical postoperative
patients, or near the telemetry floor for
patients who have life-threatening cardiac
issues (e.g., cardiac care units).
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9. Services included in critical care codes
• The following services are included in critical care
codes, so coders should not report them separately:
• The interpretation of cardiac output measurements
• The interpretation of chest x-rays
• Noninvasive ear or pulse oximetry for oxygen
saturation
• Analysis of clinical data, stored in computers (e.g.,
electrocardiograms, blood pressures, hematologic
data)
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10. § Gastric intubations, requiring a physician’s skill as well
as fluoroscopy, image documentation and report
§ Temporary transcutaneous pacing (i.e., a temporary
method of keeping the patient's heart beating by
delivering small jolts of electricity to the heart)
§ Ventilatory management for patients who have been
placed on ventilators to assist with breathing
§ Vascular access procedures for the purpose of drawing
blood samples
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11. Time-based codes
• Report critical care based on the time spent providing
care. There are two codes used for critical care:
• § CPT code 99291: Critical care, evaluation, and
management of the critically ill or critically injured
patient; first 30–74 minutes.
• § CPT code +99292: Critical care, evaluation, and
management of the critically ill or critically injured
patient; each additional 30 minutes. (List separately in
addition to primary service.)
• Report code +99292 more than one time if the
physician spends more than 30 additional minutes.
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12. For example, consider the following:
§ For 75–104 minutes: Use 99291 X 1 and 99292 X 1
§ For 105–134 minutes: Use 99291 X 1 and 99292 X 2
§ For 135–164 minutes: Use 99291 X 1 and 99292 X 3
§ For 165–194 minutes: Use 99291 X 1 and 99292 X 4
The critical care codes coders assign should reflect the total
time spent for each 24-hour period the physician provided
critical care. The time does not have to be continuous. Get
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