Insurers pay strict attention to the definition of critical care when calculating reimbursement, so you'll need to keep pace by cracking open the CPT manual and studying up.
For example, vital signs may be stable, but a doctor needs constantly to watch a person whose blood pressure if 90/50. Proper documentation must be present to bill these services as critical care.
Critical care is defined in the 2003 CPT manual as "the direct delivery by a physician(s) of medical care for a critically ill or critically injured patient." A critical illness impairs one or more vital organs or systems such that the patient's survival is in jeopardy.
Critical care is also provided if there is a high probability of "imminent or life-threatening deterioration in the patient's condition." Vital signs may be stable and the patient still be considered critically ill. According to Mary Falbo, MBA, CPC, president of Millennium Healthcare Consulting Inc., a national healthcare consulting firm based in Lansdale, Pa., that specializes in financial and healthcare management with a focus on physician compliance, coding, billing and reimbursement, there are several important points to remember: