Coding Guide – Critical Care Services

Critical care is a complex service provided to a patient who has vital organ failure or to prevent further life threatening deterioration of the patient’s condition.

The CPT^® coding rules and the CMS reimbursement rules can be confusing. The payment for this time-based service is high, and payers frequently do pre or post payment review.

 

Table of Contents:

• What is critical care
• Other E/M services and critical care on the same calendar day
• Who may provide critical care
• What may be included in critical care time
• What may not be included in critical care time
• Bundled services included in critical care time
• Critical Care during the global surgical period
• Key reminders about billing critical care services
• Reviewing critical care notes

Citations:

CPT^® 2020 Professional Edition, American Medical Association
CMS Medicare Claims Processing Manual, Chapter 12, Section 30.6.12

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