CPT^® 99292, Under Critical Care Services

Summary

Critical care services include the treatment of vital organ failure  or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is not the only requirement for providing critical care service. The presence of a patient in an ICU or use of ventilation is not sufficient to bill a critical care service. The following three criteria must be met for reporting critical care services:

the severity of illness the intensity of services required to treat the illness the time spent in providing the care.

Proper documentation showing the medical necessity for providing critical care services is an absolute requirement. Usually a critical care service is provided to a patient in a "critical care area" such as the coronary care unit (CCU), intensive care unit (ICU), respiratory care unit, or emergency room.

This code is applicable for a critical care service provided for each additional 30 minutes of service after the first 30–74 minutes of direct critical care treatment provided. This is an "add–on" code and therefore must be used along with a primary CPT code.

 

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