What is the definition of critical care for billing purposes?

Critical care is the direct delivery of medical care for a critically ill or injured patient where illness/injury acutely impairs one or more vital organ systems with high probability of imminent or life-threatening deterioration. The physician must be immediately available and providing constant attention.

What are the time requirements for critical care billing?

99291 requires 30-74 minutes of critical care time. 99292 is an add-on code for each additional 30 minutes. Time must be documented and must represent direct physician critical care activities. Time does not need to be continuous but must total the required threshold.

What conditions typically qualify for critical care billing?

Qualifying conditions include: respiratory failure, shock, severe sepsis, cardiac arrest/post-arrest, acute MI with hemodynamic instability, massive hemorrhage, CNS failure (stroke, status epilepticus), multi-organ failure, major trauma, and any condition with high probability of life-threatening deterioration.

What procedures are bundled into critical care?

Bundled procedures (not separately billable): chest x-ray interpretation (71045-71046), blood gases, pulse oximetry, vascular access (routine), cardiac monitoring, temporary pacing, ventilator management, CPR, and gastric intubation. Certain procedures like central line placement (36555-36556) are separately billable.

How do I document critical care time properly?

Document start and end times or total time spent, activities performed, critical illness justification, constant attention provided, and clinical status changes. Time documentation must be specific (e.g., 'Total critical care time: 65 minutes' not 'extended critical care provided').

Critical Care Documentation (99291-99292)

Definition

Critical care is direct delivery of medical care for a critically ill/injured patient with high probability of imminent or life-threatening deterioration.

Key Requirements

1. Critical illness with life-threatening potential
2. Direct physician involvement - constant attention
3. Time-based documentation - minimum 30 minutes
4. Cannot bill other E/M for same time period
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Qualifying Conditions

Category	Examples
Respiratory	Respiratory failure, ARDS, status asthmaticus
Cardiovascular	Cardiogenic shock, cardiac arrest, malignant arrhythmias
Infectious	Severe sepsis, septic shock
Neurological	Status epilepticus, stroke with instability
Metabolic	DKA/HHS with compromise, acute liver failure
Trauma	Major trauma, hemorrhagic shock

NOT Qualifying

Stable patients in ICU (location doesn't determine critical care)
Post-op monitoring without complications
Chronic stable conditions

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Time Thresholds

Total Time	Billing
< 30 min	Cannot bill critical care
30-74 min	99291 x 1
75-104 min	99291 + 99292 x 1
105-134 min	99291 + 99292 x 2

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Bundled vs Separately Billable

Bundled (Cannot bill separately)

Chest x-ray interpretation
Blood gases, pulse oximetry
Cardiac monitoring
Ventilator management
CPR
Routine vascular access

Separately Billable

Central line placement (36555-36556)
Arterial line (36620)
Endotracheal intubation (31500)
Chest tube (32551)
Cardioversion (92960)

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Documentation Template

```
CRITICAL CARE NOTE
Date/Time: [Date] [Time]
Total Critical Care Time: [X] minutes
CRITICAL ILLNESS IDENTIFICATION
Patient is critically ill with [diagnosis] with high probability
of life-threatening deterioration as evidenced by:

[Vital sign instability]
[Organ system failure]
[Laboratory derangements]

CRITICAL CARE ACTIVITIES

[Assessment and monitoring activities]
[Data review and interpretation]
[Management decisions]
[Procedures performed - note bundled vs separate]

CLINICAL STATUS

Hemodynamic: [Status]
Respiratory: [Status]
Neurological: [Status]

ATTESTATION
I personally provided [X] minutes of critical care time,
exclusive of separately billable procedures.
I was immediately available throughout this period.
```

Critical Care Documentation Template — 99291/99292 Billing

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