How do you define Critical Care CPT Codes?

Critical care – what is it? And how do you define it from a coding standpoint? Here is an easy and straightforward way how providers can think about it.

First, is the patient critically injured or ill? More essentially, is there an injury or illness impairing one or multiple organ systems, resulting in life-threatening deterioration in the patient’s condition highly likely now or later? Second, is critical care treatment being provided to the patient to make him/her better?

The American Medical Association defines critical care as – “A critical illness or injury [that] 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 … Providing medical care to critically ill or injured patient qualifies as critical care only if both the illness/injury and the treatment being provided meet the … requirements … Critical care is usually, but not always, provided in a critical care area … or emergency department.

Is critical care considered to be a shared or split service?

The answer, interestingly, is “no.” An advanced practice provider (APP; PA or NP) and a physician can work together to take care of critically injured or ill patients on a hospital floor or intensive care unit. Although, they cannot bill for such care as a shared service.

The critical care services CPT codes, unlike the other evaluation and management (E/M) services, projects one physician’s (or APP’s) care and management of a critically injured or ill patient for a particular reportable time period. In other words, it is not possible to report a shared/split critical care services performed together by an APP and a physician. Rather, every critical care service reported should reflect the treatment, management and evaluation of the patient by that APP or individual physician.

Critical care is a time-based service. The first 30-74 minutes of critical care on a said date of service for a single provider is reported by the use of CPT code 99291. It is used to report additional block(s) of time, of up to 30 minutes each, beyond the first 74 minutes of critical care.

Join this session by expert speaker Ray Cathey, PA, FAAPA, MHS, MHA, CMSCS, CHCI, CHCC, where he will assist and motivate providers and office billing staff to document and code to the highest level of specificity. This knowledge will help you position yourself for a positive impact of the new payment systems on your medical practice.

Source file: AMA Critical care predefined coding

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