Use critical care codes correctly to ensure compliance

New payment policy guidelines issued by CMS will have a vital effect on how critical care services should be documented and billed. To understand how critical care differs from other E/M codes, providers should study the newly revised CMS policy MM5993.

CPT defines critical care as the direct delivery of services by a physician for a critically ill or injured patient.

These services must encompass treatment of “vital organ failure”—such as failure of the central nervous, circulatory, renal, hepatic, metabolic, or respiratory systems—and “prevention of further life-threatening deterioration in the patient’s condition.”