How to Bill for Critical Care Services?

Professionals in critical care medicine diagnose treat a wide range of illnesses. Even though critical care services have only two codes, reporting them might be difficult due to the norms and regulations involved.

In reality, the way critical care services are billed is scrutinized by Medicare and commercial payers. It is critical to keep track of medical necessity documentation. Expert coding and critical care coding medical billing services can help physicians charge critical care accurately based on the paperwork.

Key things to understand

The professional services provided to patients with a serious disease or injury are known as critical care services. It is vital to understand what defines critical care to appropriately report the services.

Critical care has been defined by both CPT and Medicare. "Critical care is the direct administration of medical care for a critically ill or critically damaged patient by a physician(s) or other certified health care provider," according to CPT 2017. Critical care is making high-stakes decisions to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/or avoid further life-threatening deterioration of the patient's state."

Critical care services are medical services provided to individuals who have a serious illness or injury. It's crucial to know what critical care is to properly report the services.

Documenting Time

Adult critical care services are coded using two CPT codes:

99291 Critical care, examination, and management of critically ill or injured patients. The time period is only 30–74 minutes

99292 Critical care, examination, and management of patients who are critically ill or injured; each extra 30 minutes.

Code 99291 denotes the first 30-74 minutes of critical care on a specific date and should only be used once per date, even if the physician's time spent on that date is not continuous. Beyond the first 74 minutes of a calendar day, code 99292 is used to indicate extra blocks of time of up to 30 minutes each.

Documentation is the key

Proper documentation is very important. In general, physicians should keep track of all procedures performed, medical necessity indicators, diagnostic or exam findings used to confirm medical necessity, other interventions attempted, how the procedure was performed, any supplies used, the procedure's success or failure, any tests performed to confirm the procedure, date and time, and signature.

The Patient's Situation

The patient's health, the level of care management, and the time spent are all crucial components to be noted during critical care treatments. For example, critical care services must be billed if the patient has "a serious illness or injury that significantly damages one or more vital organ systems to the point where there is a high possibility of imminent or life-threatening deterioration in the patient's condition." An illness or damage of this nature should be meticulously documented.