Medicare_Claims_Processing_Manual / Chapter_12 / 30.6.12

Why This Topic Matters

Critical care claims are highly time- and documentation-sensitive, and this guidance helps readers recognize when services fall within Medicare’s reporting framework versus when other evaluation and management reporting may apply. It is especially relevant for hospital-based, emergency, intensive care, trauma, and burn settings.

Article Sections

1. Use of Critical Care in Cases Which Are Not Medical Emergencies

   Explains the general scope of critical care services and the settings in which they may be furnished. It also distinguishes critical care from other hospital and consultation services in broad terms.

2. Constant Attendance or Constant Attention as Prerequisite for Use of Critical Care Codes

   Describes the time-related and availability requirements associated with reporting critical care. The section also addresses where work may be performed and the need for documentation in the medical record.

3. Hours and Days of Critical Care

   Discusses whether critical care reporting is limited to a fixed number of days and notes Medicare review considerations for unusually large amounts of reported care.

4. Counting of Units of Critical Care Services

   Summarizes the time-based structure used for reporting critical care units and includes a broad illustration of how reported duration corresponds to billing patterns.

5. Critical Care Service and other Evaluation and Management Services Provided on Same Day

   Addresses coordination of critical care with other evaluation and management services provided on the same date. It also discusses documentation expectations when multiple services occur on one day.

6. Critical Care Services Provided During Preoperative Portion of Global Period of Procedure With 90 Day Global Period in Trauma and Burn Cases

   Covers Medicare guidance for critical care furnished before surgery in trauma and burn situations during a global period. The section discusses the related reporting and documentation framework at a high level.

7. Critical Care Services Provided During Postoperative Period of Procedure With Global Period in Trauma and Burn Cases

   Covers Medicare guidance for critical care furnished after surgery in trauma and burn situations during a global period. The section discusses the related reporting and documentation framework at a high level.