Critical Care Time is one of the areas where we see an opportunity. Please use this table when calculating and coding for critical care services.
| Counting Critical Care Time Table | |
|---|---|
| Total Duration of Critical Care | |
| <30 minutes | 99232 or 99233 |
| 30-103 minutes | 99291 X 1 |
| 104-133 minutes | 99291 and 99292 X 1 |
| 134-163 minutes | 99291 and 99292 X 2 |
| 164-193 minutes | 99291 and 99292 X 3 |
| 194-223 minutes | 99291 and 99292 X 4 |
Critical Care Services are not billed just because the patient is in the ICU. Critical care services must be medically necessary based on the following definition. The direct delivery by a physician(s) or other qualified healthcare professional (QHP) of medical care for a critically ill/injured patient in which there is acute impairment of one or more vital organ systems, such that there is a probability of imminent or life-threatening deterioration of the patient’s condition. It involves high complexity decision-making to treat single or multiple vital organ system failure and/or to prevent further life-threatening deterioration of the patient’s condition.
Time - may be continuous or aggregated provided by the provider on a given date of service. Per CPT – critical care time that can be considered for level of service is time spent engaged in work directly related to the patient’s care whether that time was spent at the immediate bedside or elsewhere on the floor or unit. Time spent on activities that occur outside of the unit or off the floor, such as telephone calls that are taken at home or in the office, or elsewhere in the hospital will not be counted towards critical care as the provider is not immediately available to the patient.
Time spent performing separately reportable procedures or services should not be included in the time reported as critical care time.