critical care time

It is often difficult for a physician to decide whether to bill their patient for admission or critical care. This article will aid you or anyone working at a healthcare facility differentiate critical care services from any other service provided by your healthcare facility. Knowing the key points for billing and coding critical care services is essential to make your hospital management system efficient and feasible.

Usually, critical care units will be seen occupied with patients facing the failure of their vital organ(s) such as CNS failure, intensive shock or trauma, respiratory failure, hepatic failure, etc. The latest technologies and machinery are used to treat these patients. The system required for critical care is complex and extensive. Hence, coding of critical care time and critical care billing is essential.

What is critical care?

Critical care is the practice of provision of medical care for people who have life-threatening illnesses or injuries. While it’s similar to the ICU, it mostly caters specifically to those with cardiac disorders or other rapidly deteriorating conditions.

The average critical care time in a critical care unit ranges from one to six days. Once a patient’s critical care time is over and their critical care billing is handled, they are shifted to a cardiac ‘step-down unit’ where they are provided with reduced intensive care.

What are critical care codes?

Critical care time is essentially noted in codes to provide respected critical care billing. Some of the major critical care time codes are mentioned below.

  • The CPT code 99291 codes for the critical care, management, and evaluation of a critically injured patient for a specific range: 30-74 minutes.
  • The CPT code 99292 codes for the critical care, management, and evaluation of a critically injured patient for the range of 75-105 minutes.

For every additional 30 minutes, the code increases by a number in the unit digit, such as:

  • CPT code 99291×1 and 99292×2 for 105-134 minutes
  • CPT code 99291×1 and 99292×3 for 135-164 minutes
  • CPT code 99291×1 and 99292×4 for 165-194 minutes

The time spent by a patient in critical care does not necessarily have to be continuous. Critical care attendants must document the details of the care provided to the patient along with their critical care time.

critical care billing

While critical care billing comprises the time and care provided to the critically ill patient, the patient may also be charged for other facilities. This include:

  • The time spent by the physician on reviewing test results
  • Consulting other staff members of the healthcare facility about the patient’s critical care
  • Reaching a diagnosis and treatment
  • Documenting critical services in the patient’s medical record in the healthcare facility

What services do critical care codes provide?

Critical care coding is responsible for the following medical decision-making and assessment complexities.

  • Chest X-Ray interpretation (CPT codes 71010-71020)
  • Cardiac output measurement interpretation (CPT codes 93561-93562)
  • Checking oxygen saturation via pulse oximetry or noninvasive ear oximetry (CPT codes 94760-94762)
  • Intramuscular or intravascular access procedures for injecting a certain medication or fluid or for drawing of blood samples (CPT codes 36000, 36410, 36415, 36450, 36600)
  • Analysis of data obtained by power labs and cardiac output, such as electrocardiograms (ECG), blood pressures, and blood compositions (CPT codes 93561-93562)
  • Temporary transcutaneous pacemakers, which serve as alternative methods of keeping the patient’s heart activity continuous by providing small amounts of voltage to the heart for a short period (CPT code 92953)
  • Management of a patient’s access to ventilators to assist them with their breathing (CPT codes 94002-94004, 94660, 94662)
  • Gastric intubations and fluoroscopy, which a combination can deliver of a physician’s skill as well as the ability of a GP to assess the image documentation and reports (CPT codes 43572, 91105)

Other activities performed by the physician to treat critically ill patients are specially mentioned as they do not have a code for their assessment.

critical care coding guidelines 2020

Critical care coding criteria

This criterion was set by the critical care coding guidelines 2020. If not met by the patient, it makes them ineligible to receive treatment in the critical care units.

  • The patient must be critically ill or critically injured. They must have a critical diagnosis or symptom(s).
  • Critical care service should be offered for 30 minutes or greater. A lesser period does not qualify the patient to be coded for their time in critical care.
  • The physician allotted to the patient provides them with all of their attention and can not cater to other patients’ needs in that time.
  • The physician is required to enter the patient’s medical records, including the time spent providing them critical care.
  • Critical care provided to the patient by their physician must include complex assessment of reports and medical decisions.

The condition or situation in which the patient is not eligible for the usage of critical care billing and coding includes:

  • Patients in intensive care units or other hospital wards whose conditions do not meet the definition of critically ill or critically injured.
  • In cases of lesser time spent in the critical care unknit than what is coded for, appropriate codes should be used.
  • Patients whose critical care is related to the surgery they have had recently are situated in post-operative wards.

Services not included in critical care time are hence, not coded for, are mentioned below:

  • Updating family members who are not involved in making any medical decisions for the patient.
  • Off-unit time spent by the physician, where no care was provided to the patient directly.
  • Time allotted to the physician for the routine follow-ups of their patient.
  • Time spent on researching the patient’s condition and presenting a proper diagnosis.
  • Time spent teaching the interns, residents, and other healthcare providers about the critically ill patient’s condition.
  • Time spent by the physician caring for other patients either in the same unit or another.
  • Separate procedures performed unrelated to the critical care of the patient are performed.
critical care billing

Critical care billing guidelines

Consistent and reliable determination of the critical care services delivered to the patient have requirements that need to be met accordingly.

As mentioned above, the clinical condition criteria revolve around a high-risk illness or a sudden clinically significant and life-threatening retrogression in the patient’s condition. This requires the urgent intervention of the highest-rated physicians in the healthcare facility.

The treatment criteria include critical care services that require direct intervention, which is also allotted to the specific patient. These interventions are highly technological and include life and organ supporting services that require frequent monitoring and personal assessment by the physician. Withdrawal of or failure to initiate these interventions in a timely and efficient manner is likely to result in clinically significant deterioration of the patient’s health condition.

See Also: ICD-10 Codes – Correctly Coding Type 1 Diabetes Mellitus


It is important to realize that critical care is based on the patient’s condition and not on their location. The takeaway from this article is that providing medical care to a critically ill patient should not be automatically classified as a critical care service just because the services cater to a critically injured or ill patient. If, in any case, the criteria set for coding for critical care services do not meet, the patient is not eligible for critical care and hence, critical care billing.

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