Professional Critical Care Billing Company Critical Care Billing Specialists

CPT 99291 covers the first 30-74 minutes of critical care services provided to a critically ill patient. Once you exceed 74 minutes, you bill 99292 for each additional 30-minute increment. For Medicare patients as of 2023, you must complete the full 30-minute interval (104 total minutes) to add 99292. Other payers allow partial increments. Time must be clearly documented and includes only direct patient care activities, excluding separately billable procedures.

A critically ill patient has acute impairment of one or more vital organ systems with high probability of life-threatening deterioration without immediate intervention. This includes conditions like septic shock, respiratory failure, cardiac arrest, or multi-organ dysfunction. Critical care isn't determined by location (ICU admission alone doesn't qualify) or diagnosis alone. Documentation must demonstrate active management preventing deterioration or death, not just monitoring a stable patient.

Bundled procedures that count toward total critical care time include ventilator management, chest x-ray interpretation, blood gas analysis, EKG interpretation, pulse oximetry, gastric intubation, and peripheral vascular access. Separately billable procedures include endotracheal intubation, central line placement, arterial line insertion, chest tube placement, pulmonary artery catheter insertion, and CPR. Proper separation prevents claim denials and maximizes reimbursement.

Yes, through split/shared critical care billing. When physicians and non-physician practitioners from the same group provide services on the same date, their combined time determines billing codes. The provider contributing more than 50% of total time bills with modifier FS. Each practitioner must document their individual contribution and time spent. This allows intensivist teams to accurately capture collaborative critical care efforts.

Essential documentation includes total time spent (start/stop times), specific organ systems requiring intervention, diagnostic parameters evaluated, therapeutic interventions performed with rationale, and ongoing risk of deterioration without continued care. Avoid generic templates or dot phrases. Clearly articulate medical necessity showing why immediate physician attention prevented likely death or serious deterioration. Time spent must exclude non-billable activities like teaching, family updates, or off-unit management.

No. Critical care services can be billed in any location where qualifying conditions exist, including emergency departments, step-down units, or general floors. The determining factors are patient acuity and medical necessity, not physical location. A patient receiving time-based critical interventions in the ED qualifies equally to an ICU patient. Conversely, an ICU patient requiring only monitoring without active intervention doesn't qualify for critical care codes.

Our specialists track time meticulously, separating bundled procedures from separately billable services. We calculate exact minutes for 99291/99292 coding, ensuring Medicare's stricter 2023 increment requirements are met while maximizing reimbursement under other payer rules. We audit documentation for completeness, flag missing time stamps, and train providers on accurate time capture methods. This precision reduces payer disputes and increases clean claim rates.

Critical care requires time-based documentation rather than complexity-based leveling, involves bundled procedure rules that vary by payer, demands specific medical necessity language proving life-threatening conditions, and includes split/shared billing scenarios with multiple providers. Coders must understand which interventions count toward time, when procedures warrant separate billing, and how Medicare differs from commercial payers. This specialized knowledge prevents undercoding and compliance violations.

Most intensive care units complete implementation within seven business days. We initiate with documentation review, configure time-tracking systems for CPT 99291/99292 compliance, establish payer-specific billing protocols, and train clinical staff on proper time capture. Our phased approach ensures zero disruption to current operations while optimizing revenue from day one.

Our pricing adapts to your facility's volume and complexity, providing customized solutions that align with your intensive care unit's case mix, payer distribution, and documentation workflows.