Crystal's MCW Coder HubTags: cpt critical-care inpatient
Overview
Critical care services are for patients who are critically ill or injured.
Primary Codes
| CPT | Description | Time |
|---|---|---|
| 99291 | Critical care, first 30-74 min | 30-74 min |
| 99292 | Critical care, each addl 30 min | Each 30 min |
Critical Care Definition
CMS Criteria
Patient must have:
- Vital organ system failure
- High risk of mortality
- Requires constant physician attention
Billable Activities
Included in Critical Care Time
- Bedside care
- Review of labs/imaging
- Documentation
- Communication with family (about care)
- Care coordination
NOT Included
- Procedures with separate CPT codes
- Teaching activities
- Travel time
- Administrative tasks
Common Procedures Bundled
| Procedure | Bundled? |
|---|---|
| 36000 - IV insertion | Yes |
| 36415 - Venipuncture | Yes |
| 43752 - NG tube | Yes |
| 94002-94004 - Vent management | Yes |
| 99291 - Critical care | No (primary code) |
Separate Procedures (Billable)
| Procedure | Code | Modifier |
|---|---|---|
| Central Line | 36556-36558 | None |
| Arterial Line | 36620 | None |
| Intubation | 31500 | None |
| Chest Tube | 32551 | None |
Time Documentation
Document total critical care time. If <30 minutes, bill appropriate E/M code instead.
Same Day E/M
| Scenario | Billing |
|---|---|
| E/M + Critical Care | E/M with Modifier 25 |
| Critical Care Only | 99291 (+ 99292 if applicable) |
| Multiple Sessions | Aggregate time same day |