Daily Bolus of LR: Qualifying Activities for Critical Care Billing

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September 19, 2011 by dailybolusoflr

Qualifying Activities for Critical Care Billing


When billing “Critical Care” time in the ED, patients must meet the clinical condition criterion.  This means that there is a high probability of sudden, significant, or life threatening deterioration in the patient’s condition that requires the highest level of the physician’s care in an urgent manner.

Critical care time can only be billed after 30 minutes has been provided.  Time between 30 and 74 minutes bills at one level.  Every additional 30 minutes after 75 minutes bills an additional level of care.


When documenting these activities, physicians must document the TOTAL amount of critical care time that they are billing for the individual patient.  Allowed critical care activities include the following:


·         The total time spent with the patient

·         Time spent reviewed the patients tests

·         Time spent talking to staff about the patient’s care

·         Time spent documenting

·         Time spent with family discussing the patient’s condition BUT ONLY as it is required regarding obtaining history when the patient is unable or when there is need to discuss treatment decision.  (ie- time spent updating family on how the patient is doing does NOT count for critical care)


Ref: Medical Account Services Billing

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