Coding Critical Care
Critical Care services codes report the direct delivery of medical care to a critically injured or critically ill patient. As per CPT, “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.”
It is important to note that Critical Care is a condition, not a location. A patient does not have to be in an intensive care unit (ICU) or other designated area to meet the requirements of critical care. And not all patients in an ICU, or other designated units, qualify automatically for critical care. Any patient meeting the definition of critically ill or critically injured may qualify for critical care services.
CPT bundles several services, such as cardiac output measurements (93598), typically required for critically ill or critically injured patients. Any procedures that are not bundled in the Critical Care Services codes can be separately reported (for example, 31500 Intubation, endotracheal, emergency procedure). The physician must document that the separately reportable procedures were not included in the critical care time. CPT guidelines state, “Time spent performing separately reportable procedures or service should not be included in the time reported as critical care time.” You can find the list of Critical Care bundled services in the CPT code book in the Critical Care subsection.
Critical Care Services codes are reported based on the time the physician spent dedicated, and directly available, to the patient. The physician cannot work on any other patient during this time; however, the time is not required to be continuous, and the physician is not required to be in the same room as the patient. The physician can report only time spent on the same unit or floor as the patient.
Q: True or False: Critical Care services can only be delivered in an ICU setting.
A: False. A patient does not have to be in an intensive care unit (ICU) or other designated area to meet the requirements of critical care. Nor do all patients in an ICU, or other designated unit, qualify automatically for critical care.
Reference: FY 2023 CPT code book (Critical Care Services subsection in the CPT code book)
