Critical care help


Norristown, PA
Best answers
Is there a chance that anyone has more specific written guidelines in regards to critical care coding and what exactly is needed? I feel that what is listed in the guidelines can be misconstrued and therefore overcoded. I'm asking because we have a doctor who will see a patient straight for 10 days in the ICU and bill critical care every day. He documents the time, but just because he is spending 35 minutes and the patient is on a ventilator does it really mean he is doing critical care??? Let's say we are on day 4 and there isn't any change to the patient (pt still has VDRF and unresponsive), no meds are being added or discontinued and no discussions to relatives or other doctors about patient care, is he really doing critical care if he documents time spent?? I need something more concrete to present because I feel that it totally is being misused. Am I wrong? If anyone has any insight, it would be greatly appreciated.


The medicare policy for critical care billing on the WPS website is excellent. It gives specific examples of when to bill for critical care and when not to. I would recommend reading that if you haven't already done so. The policy number is PHYS-022.

Let me know if that helps or not.

Thank you!
Terri Steinke
critical care

Most important thing is "critical care" does not only occur in the ICU or CCU. EM needs to clearly state what the critical illness is and how it was managed by that physician