A 72-year-old man with chronic obstructive pulmonary disease (COPD) is admitted to a medical unit with pneumonia. Overnight, his oxygen requirement increases from 4 L/min via nasal cannula to high-flow oxygen. During morning rounds, he becomes increasingly tachypneic. An arterial blood gas reveals acute hypercapnic respiratory failure with a pH of 7.24 and PaCO2 of 72 mmHg.
You urgently evaluate the patient, review laboratory studies, chest imaging, and arterial blood gas results, discuss management with respiratory therapy, initiate BiPAP, adjust medications, perform serial reassessments, and discuss the potential need for intubation and ICU transfer with the intensivist. You spend a total of 45 minutes managing the patient’s acute respiratory failure.
What Level of Billing Is Appropriate?
This encounter supports billing for critical care services (CPT 99291). The physician’s work involves high-complexity decision-making directed at treating acute respiratory failure and preventing further life-threatening deterioration.
Tip
Critical care billing is based on the severity of the patient’s condition and the physician’s work performed—not the patient’s location. A patient does not need to be admitted to the ICU or require invasive mechanical ventilation to qualify. CPT 99291 may be reported when 30 to 74 minutes of qualifying critical care services are provided. CPT 99292 may be reported for each additional 30-minute increment of qualifying critical care time beyond the initial service.
Dr. Garg
Dr. Garg is chair of the department of medicine, physician lead of the hospitalist group, secretary-treasurer of the medical executive committee, and glycemic excellence physician lead at Providence Medford Medical Center in Medford, Ore. She is also vice president of SHM’s Oregon/SW Washington chapter.