Critical Care Code

Question: Can I bill a critical care code if a patient becomes seriously ill while in my office?

Answer: Yes, you just have to meet the requirements for critical care, which is a timed code. The reason we don't see much of it in the office is that the minimum time for reporting a critical care service is 30 minutes - and usually, the patient is transported elsewhere by then when they become critically ill in the office.

The CPT manual defines it as "direct delivery of medical care for a critically ill or injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition." There are no site-of-service restrictions.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

This question originally appeared in the January 2010 issue of Physicians Practice.