Critical Care Time
This patient required critical care. Due to the fact that the patient required a significant amount of one on one physician – patient contact time, ordering and review of studies, arranging urgent treatment with development of a management plan, evaluation of patient’s response to treatment with frequent reassessments, and discussions with other providers this patient required critical care time in excess of 30 minutes.
Critical care time was indicated due to the inherent instability and/or potential for instability in this patient.
The critical care time that is allocated to this patient is above and beyond any time spent on any other billable procedures performed on this patient.

Critical Care Time Cardiac
Given the high probability of imminent or life threatening deterioration of the patient’s condition without intervention, the patient was immediately assessed by myself and the nurse, and cardiac monitoring initiated. The patient was also placed on oxygen and continuous pulse oximetry initiated.
During the course of the patient’s stay, I spent a considerable amount of time at the bedside performing serial re-evaluations of the patient’s hemodynamic and clinical status because of the recognized potential threat to life or limb in this condition.
Clinical management of this patient involved high complexity decision making to assess, manipulate, and support vital organ system failure. I then had a chance to review all of the available laboratory and radiographic studies obtained today, and I also reviewed old records available to me at the time. Sequential vital signs were obtained.
Critical care time noted below was time spent engaged in work directly related to the individual patient’s care, not including time performing procedures; however it does include time spent at the immediate bedside or elsewhere on the floor or unit.
TOTAL CRITICAL CARE TIME ELAPSED: in excess of 30 minutes.
BODY SYSTEM AT HIGHEST RISK: Cardiac.

Critical Care Time Respiratory
Given the high probability of imminent or life threatening deterioration of the patient’s condition without intervention, the patient was immediately assessed by myself and the nurse, and cardiac monitoring initiated. The patient was also placed on oxygen and continuous pulse oximetry initiated.
During the course of the patient’s stay, I spent a considerable amount of time at the bedside performing serial re-evaluations of the patient’s hemodynamic and clinical status because of the recognized potential threat to life or limb in this condition.
Clinical management of this patient involved high complexity decision making to assess, manipulate, and support vital organ system failure. I then had a chance to review all of the available laboratory and radiographic studies obtained today, and I also reviewed old records available to me at the time. Sequential vital signs were obtained.
Critical care time noted below was time spent engaged in work directly related to the individual patient’s care, not including time performing procedures; however it does include time spent at the immediate bedside or elsewhere on the floor or unit.
TOTAL CRITICAL CARE TIME ELAPSED: in excess of 30 minutes.
BODY SYSTEM AT HIGHEST RISK: Pulmonary

PEARLS:

• Time calculations per WIKEM
  • Time spent in critical care activities must exceed 30 minutes in order to bill for critical care time.
    • CPT Code 99291 is used for the first 30-74 minutes of critical care time
    • CPT Code 99292 is used for additional blocks of time of up to 30 minutes beyond the first 74 minutes of critical care time
    • Must document either a specific time or, e.g., “in excess of 30 minutes”.
    • Calculated time must exclude all separately billable procedures
      • These include (but are not limited to): central line or transvenous pacemaker placement, chest tube placement, endotracheal intubation, CPR.