UMEM Educational Pearls

Category: Critical Care

Title: Critcal Care Billing Pearls

Keywords: Critical Care, reimburshment, billing (PubMed Search)

Posted: 12/20/2008 by Michael Bond, MD (Updated: 10/22/2020)
Click here to contact Michael Bond, MD

Critical Care Billing Pearls:

 

Level RVU Medicare Commerical
99285    ED E/M, Level 5   4.71 $170 $304
99291    Critical Care, first hour 5.84 $211 $363



As the table shows Critical Care billing will earn you approximately 25% more with no additional overhead.  Critical care time must be at least 30 minutes, and the following procedures are included in the critical care code:   

  • Interpretation of ABG and labs
  • Interpretation of CXR
  • IV insertation
  • Transcutaneous pacing
  • Blood Draws
  • NG Tube placement

The following procedures are not bundled into critical care time, so they can be billed separately, therefore the time you spend doing these procedures can not be included in your total critical care time:

  • Central Line Placement
  • Lumbar Puncture
  • Intubation
  • Transvenious pacemaker placement
  • Arterial Line Placement
  • Chest Tube Placement
  • CPR


Remember critical care time does not need to be continuous but you need to be immediately available to the patient for the time to count.  You can not count time going off the floor to review an xray or CT, but this time can be counted if you do it in the immediate vacinity of the patient.

FINAL CAVEAT  To help your coders bill appropriately it helps to include a statement such as "Critical Care time XX minutes where I was directly involved in the care of this patient exclusive of all other separately billable procedures."

References

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