Critical Care Code


Meeting the requirements for critical care in the office

Question: Can I bill a critical care code if a patient becomes seriously ill while in my office?

Answer: Yes, you just have to meet the requirements for critical care, which is a timed code. The reason we don't see much of it in the office is that the minimum time for reporting a critical care service is 30 minutes - and usually, the patient is transported elsewhere by then when they become critically ill in the office.

The CPT manual defines it as "direct delivery of medical care for a critically ill or injured patient. A critical illness or injury 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." There are no site-of-service restrictions.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at or

This question originally appeared in the January 2010 issue of Physicians Practice.

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