Critical Care Services

Definition:

Caring for a critically ill or injured patient

Explanation:

Critical care has high relative value units and payments so it’s important to know the coding rules. This article describes what can be included in the time of critical care what can’t be included, and the time thresholds for reporting critical care. This overview article and the video include changes made by CMS in November, 2021 effective 1-1-2022.

CPT defines critical care this way:

“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. Critical care involves high complexity decision making to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/ or to prevent further life threatening deterioration of the patient’s condition. Examples of vital organ system failure include, but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure. Although critical care typically requires interpretation of multiple physiologic parameters and/or application of advanced technology(s), critical care may be provided in life threatening situations when these elements are not present. Critical care may be provided on multiple days, even if no changes are made to the treatment rendered to the patient, provided that the patient’s condition continues to require the level of attention described above. ”[1]

[1] CPT® 2023 Professional Edition. American Medical Association, Chicago

Watch this brief overview and read on for an in depth review of billing and coding guidelines, and tips for reporting Critical Care Services.

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