CPT® defines critical care (99291, +99292) by three components:

  1. A critical illness is an illness in which “one or more vital organ systems is impaired such that there is a high probability of imminent or life threatening deterioration in the patient’s condition”
  2. A critical intervention involves “high complexity decision making to assess, manipulate, and support vital organ system failure”
  3. Critical care time is “time spent in work that directly relates to the individual patient’s care,” whether that time is spent at the immediate bedside or elsewhere on the floor or unit.

These criteria assume the physician takes an ongoing and active role in managing the care of that patient. Evidence that the above criteria have been met must be present in the medical record, along with the physician’s attestation that critical care was provided.

Some examples of vital organ system failure include but are not limited to:

  • Central nervous system failure
  • Circulatory failure
  • Shock
  • Renal, Hepatic, Metabolic, and/or Respiratory failure.

Critical care usually (but not always) is given in a critical care area such as a coronary care unit, intensive care unit, or the emergency department. Critical care may be provided in any location as long as the care provided meets the definition of critical care. Just because a patient is in the ICU, does not mean you can code critical care: If the patient is stable, he or she does not meet the criteria for critical care.