Pulmonology Coding Alert

Question: I've heard that the pulmonologist doesn't need to be in the room with a critically ill patient to bill 99291 for critical care time -- is this right? Also, can you clarify what the severity threshold is for critical care? Indiana Subscriber Answer: According to CPT, a patient must be critically ill or injured to qualify for critical care services.Critical illness or injury is defined as impairment of one or more vital organ systems creating a risk of imminent or unstable life-threatening deterioration in the patient's condition. Critical care involves high-complexity medical decision making to assess and support the functionality of vital organ systems -- all in an effort to prevent the patient from deteriorating further. According to Medicare, "Critical care includes the care of critically ill and unstable patients who require constant physician attention, whether the patient is in the course of a medical emergency or not." But "constant physician [...]