Coding Guide – Critical Care Services

Critical care is a complex service provided to a patient who has vital organ system failure or to prevent further life-threatening deterioration of the patient’s condition.  The CPT® definitions and instructions regarding critical care haven’t changed. However, CMS’s 2023 time rule indicates that Medicare is not following CPT’s time chart this guide discusses that.

The 2018 Medicare CERT report found a 19.7% error rate in critical care services. Of those, almost 40% were denied because of insufficient documentation.

Table of Contents:

• What is critical care
• E/M services and critical care on the same calendar day
• Reporting by more than one clinician
• 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

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