This article reviews the Current Procedural Terminology (CPT®) criteria and code categories for reporting pediatric critical care. Topics covered include
The CPT definitions for critical illness or injury guide physicians and other qualified health care professionals (QHPs) when determining whether a critical care service may be reported.
The intensity of critical care services is also described in CPT guidelines.
Documentation must support the critical nature of the patient’s presenting problems, key findings from interpretation of data, descriptions of services provided to support vital organ system functions (eg, cardiovascular and ventilatory support) and outcomes of the services provided. Time must be documented when critical care codes are selected based on time. Distinctly document time spent in critical services and time spent performing separately reported services.
Critical care services may be provided in any setting (eg, physician clinic, emergency department, hospital unit).
Codes for critical care vary based on...