Critical Care Isn't Just for the Emergency Department  

The critical care codes may be listed in CPT's Evaluation and Management section, but they play by a different set of rules. That does not mean, however, that reporting these services has to be difficult.

Critical care is the physician's direct delivery of medical care to a critically ill or injured patient, according to CPT and the Centers for Medicare & Medicaid Services (Medicare Claims Processing Manual, Chapter 12, §30.6.12(A)). And a critical illness or injury is one that "acutely impairs one or more organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition," both CPT and CMS add.

During critical care services, the physician has to provide high-complexity medical decision-making "to assess, manipulate, and support vital system function(s) to treat single or multiple vital organ system failure and/...