Critical Care Overview

CPT/CMS Definition of Critical Care Service 

An illness or injury that 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.   Critical care services are a physician’s direct delivery of medical care for the critically ill or injured patient. Examples of vital organ systems include, but not limited to: 

  •  CNS failure  
  • Circulatory failure
  • Shock (sepsis)
  • Renal, hepatic, metabolic, and/or respiratory failure

To meet CC requirements, answer YES to all 3 questions: 

1.    Is at least one vital organ system acutely impaired?
2.    Is there a high probability of imminent, life-threatening deterioration?
3.    Did you intervene to prevent further deterioration of the patient’s condition?

Critical Care Statements

**In addition to YES, the Physician request and time requirement greater than 30 minutes must be met**“I provided XX minutes of critical care to this patient to treat and/or prevent clinically significant deterioration that could result in (state the condition) not including any procedures performed” “Total critical care time was XX minutes of direct attention while the patient was critical, not including time spent performing other procedures”

Chief Complaints or Diagnosis that could be Considered for Critical Care: 

  • Cardiac Arrest 
  • Respiratory Arrest
  • Respiratory Distress
  • GI Bleeds
  • Unstable Angina
  • Acute Myocardial Infarction
  • Critical Care when you are sending to Heart Cath. Lab
  • All strokes going to the Radiology Cath. Lab 
  • Critical Care when patient is in any kind of Shock
  • Aneurysms, Brain Bleeds, Trauma
  • Cardiac Arrhythmia’s
  • Acute Allergic Reaction