CPT^® 99291, Under Critical Care Services

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 CC services. Presence of a patient in an ICU or use of ventilation is not sufficient to bill a CC service. The following three criteria must be met for reporting CC service:  

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

Proper documentation showing the medical necessity for providing CC 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 first 30 – 74 minutes. Any CC service provided for less than 30 minutes should be billed with the appropriate level of E/M code.

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