Critical Care - Answering the Most Sensitive Call to Duty

Many times when a person has been severely injured they will be placed in the critical care unit of a hospital. This unit is designed for those people that are looking at a fatal condition or illness. These people require constant care around the clock.

The people who work in a critical care unit are considered to be the "angels" of the medical world. The people, who have devoted their lives to taking care of these ultra-sensitive patients, have made a commitment to providing care to those that are in a critical care situation.

Many of the patients consist of either people that are facing a terminal illness or have had some sort of trauma that requires special attention be given to their medical issues. These patients are often times given a low chance at recovery, but the nurses that work this unit see things in a different way, they see each patient as a chance at survival and renewal of life.

Beyond the care that they provide the patients, there is the human side that is often times shown to the family of these patients. Many times the families feel like there is no one there for them when they need someone. The nurses that work a critical care unit have a way of listening to a person and letting them know they are not alone in this issue.

This reassurance can often times be comforting to a person when they need it the most. It is the job of these nurses to be there both for the patient and the family. There have been a lot of changes that have come to the critical care unit since the early days in the 1920's.

Today many critically injured patients are given a better chance at survival given the advancements that have been made in the world of medicine. There was a time when a person that was admitted to one of these units was not expected to recover.

There is a lot more of training that one of these nurses will need to go through. The reason behind this is due to the fact that a nurse in the critical care unit has to be in a position to provide extra care than what a standard nurse is used to. There is a longer training and certification period that is required for these nurses.

These nurses are also a vital part of an emergency room. They are often times the first ones that come across a trauma case in the ER. These nurses and staffers have a special ability, due to their work in critical care, to address the unique challenges of the ER and its patients.

As long as there are critical care patients, there will be a need for trained people to work these units. There will continue to be advancements in medicine that will help in the recovery process. This will lead to a person being able to recover from these life threatening situations and as a result will allow them to leave the hospital after making a full recovery.

Urgent Care Clinics Booming in Difficult Healthcare Market

The economic downturn, looming entitlement reforms and potential budget cuts in the United States at the federal and state level are allowing the growth of urgent care clinics, otherwise known as immediate care clinics, to substantially increase. This is considered to be a remedy to fill in the growing doctor shortage.

According to industry reports and spending by large healthcare operators, the number of urgent care clinics is projected to soar within the next decade. It is estimated that more than 8,000 urgent care clinics have been established - other numbers show 9,000 - and the Urgent Care Association of America reports eight to 10 percent annual growth.

Urgent care facilities are different than traditional hospitals and are rather similar to the health clinics found in places like Walmart and Walgreen because they are usually open on evenings and weekends and treat common health issues - some immediate care clinics do offer additional services like X-rays for broken bones.

Some medical professionals like to consider their urgent care clinics as after-hours doctors' offices. Most of those who work in such an office do note, however, patients may not get to see a board-certified doctor or another kind of specialist.

A large percentage of walk-in clinics and urgent care offices are managed and operated by non-profit health systems, which receive donations and contributions in order to pay for construction and renovation costs, patient care program support, general operations costs and equipment purchases, according to the Association for Healthcare Philanthropy's (AHP) annual Report on Giving study.

With so many of these operations setting up in malls, main streets and in major metropolitan cities, can the non-profit sector even pay for them? Well, Reuters is reporting that private equity firms have been investing money into urgent care clinics over the past few years. Although there is a tremendous risk in investing in these clinics because of the possibility of oversaturation and low insurance reimbursements, these firms work one-on-one with clinics to provide quality and to make profit.

Rand Health found that retailers are entering the healthcare marketplace too. Big box stores, such as Target and Walmart, only had a few of these clinics in the year 2000, but today there are more than 1,200.

"Retail clinics emphasize convenience, with extended weekend and evening hours, no appointments, and short wait times," the organization states in its report. "More than 44 percent of retail clinic visits take place when physician offices are typically closed. Price transparency and low costs may also be particularly attractive for people without insurance."

This is surely part of the profit-motive for these corporations.

Regardless of the concerns one may have over the private sector getting involved in such an industry, urgent care clinics are part of the nation's future healthcare market, especially since President Obama's Affordable Care Act is now law of the land and will add a burden to the system.

"Many factors could influence the future of retail clinics in the U.S. First, the growing body of evidence casting doubt on quality-of-care concerns could lead to greater acceptance and use of retail clinics," Rand added.

"Full implementation of the Affordable Care Act (ACA) could also lead to continued retail clinic growth. With more people insured and an increased demand for primary care under the ACA, access to primary care physicians could decrease. This may lead to increased demand for retail clinics. Similarly, if wait times for physician appointments increase-as has been the case in Massachusetts following its health reform-this could also increase retail clinic demand."

Despite the concerns that some may have about private investment possibly cutting costs to increase its bottom line, urgent care clinics must offer remedies to health issues otherwise the consumer will go elsewhere to receive proper medical attention.

Critical Care Insurance - Is it Right For You?

While it is true that the quirky Aflac duck has brought awareness to consumers about supplemental insurance, many individuals are not clear what it is and if they need to have it. Supplemental insurance, put simply, is insurance that provides additional financial benefits to the policyholder that traditionally fall outside the realm of a typical health insurance policy. Aflac's "specified health event protection" plan, also packaged by other companies as a "critical care" plan, is an insurance plan that pays the insured for benefits such as hospital and intensive care confinement; major organ transplantation; ambulance costs; waiver of premium benefits and transportation and lodging compensation as needed during the treatment of a critical illness. If the medical facility is within a certain mile radius of a policyholder's home, often the insurance company will pay a small per mile fee to the policyholder for traveling expenses for extended treatment. Each company's policy varies so it is important to ask questions and read the brochures thoroughly to see what benefits are actually covered in the plan you are considering.

Anyone that already has a health insurance policy will already have coverage for the medical expenses incurred from a debilitating accident or illness. But the health insurance policy, of course, does not include the various expenses associated with a patient's long-term care. So, who needs a critical care policy? Let's take a closer look to see if a critical care policy would be advantageous for you.

First of all, a critical care policy provides a layer of financial protection beyond the conventional health insurance policy much like a savings account protects an individual's checking account balance. If an individual inadvertently overdraws the checking account, then the bank uses funds from his/her savings account to protect the consumer's buying power. Likewise, when medical bills are mounting due to a serious medical condition, the insurance company releases funds directly to the consumer rather than to the hospital so that the insured is free to pay incoming medical bills or other expenses related to the medical condition. An insured could actually take the funds released to him/her from the supplemental insurance plan to help pay the mortgage or to buy meals at the hospital. In this way, the supplemental plan bridges the gap between a traditional health insurance policy and actual expenses occurred.

Secondly, unlike a conventional health insurance policy, an individual's "critical care" policy is guaranteed renewable each year. Therefore, once diagnosed with a condition, such as end-stage renal failure, at policy renewal time, the insurance company guarantees to renew the individual's policy in spite of the mounting medical bills.

To determine if a critical care insurance policy is right for you, take a personal inventory. Is there a history of chronic health problems, such as heart failure, stroke or cancer? (Please note that some policies do not include cancer as a covered peril. Aflac, for instance, sells a cancer policy separately that provides benefits that are specifically geared toward the medical procedures related to cancer treatment.) A history of chronic illness is a good indicator that critical care insurance may be an excellent option for you.

Next of all, consider your personal finances. Do you have the discipline to set aside money monthly to cover long-term medical care due to critical illness? And do you have an adequate income to prepare for such an event? Costs for a year of nursing home care can range from $50,000 and higher. A part-time aide can cost as much as $10,000 per year. That is a year's salary for many individuals.

And finally, get at least three quotes before you purchase a policy. Compare the policies to be sure that the premium you will pay covers your greatest medical and financial needs. Don't forget to factor your age into the equation when deciding if the monthly premiums will eventually pay off to your benefit.

How to Become a Critical Care Nurse

A critical care nurse is a professional who deals with seriously ill patients in the intensive care unit. They do not only care for the patients, but also help doctors administer treatment and monitor the conditions of the patients. The service of critical care nurses is highly important and can mean the difference between success and failure of a medical endeavor. In some cases, they can also save the lives of patients. As such, a career in critical nursing can be very stressful and requires extraordinary commitment and genuine passion to help others. Although it is a challenging job, it can also bring great fulfillment. If you wish to become a nurse, it is advantageous to know exactly what the job entails.

Job Profile

The duties of a critical care nurse include caring for patients, checking and monitoring the vital signs of patients, administering appropriate medicines and helping doctors perform treatments. As a critical nurse, your job is more pressurizing than that of a regular nurse as a result of the critical nature of the illnesses of the patients under your care. When critical symptoms show, you must act in an efficient manner to ensure that the appropriate treatment will be administered as soon as possible. You also have to work with many different kinds of medical equipment, including life support systems.

What It Takes to Become a Critical Care Nurse

To become a successful nurse, you must be very attentive as you will be required to provide information regarding patients to the doctors. You are responsible for detecting symptoms in patients and must be constantly prepared for the unexpected as life-threatening symptoms may present at anytime. It is also important that you possess strong knowledge of medications and treatment methods, as well as their effects on patients. You will be required to work closely with doctors and must be prepared to work long hours when emergencies occur. Attention to detail, a strong will and calmness are some of the traits that you need to possess to excel in the field of critical care nursing.

Education Requirements

An education in nursing is a must for anyone who wishes to become a critical care nurse. There are many schools that offer excellent nursing courses and programs that are appropriate for a critical nursing career. If you want to learn the basics of nursing, you can opt for a diploma or Associate Degree in nursing. A Bachelor's Degree or Master's Degree in nursing will prepare you for greater career advancement, making you eligible for top critical care nursing positions in the best medical facilities. Typically, nursing programs cover areas of study such as human anatomy, illnesses, medications, and nursing procedures. After obtained the required nursing education, you must obtain an advanced practice certification or a cardiac care certification before you seek employment.

Career Opportunities and Salary

Critical care nurses are in high demand nowadays and you can be assured that you win a great position once you have graduated from nursing school. Most critical care nurses work in hospitals, but there are some who work in nursing schools, outpatient surgery centers, clinics, nursing schools and private homes. With enough experience serving as a critical care nurse, you can get promoted to become a nurse practitioner, or you can even opt to become a professor in a nursing school. The average salary for a critical care nurse is $65,000 a year which may change based on the individuals drive and experience.

Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill - that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

• Level 0 is normal acute ward care.


• Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient's condition or therapy/equipment used in their care means increased intervention is needed.


• Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.


• Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

• traumatic injuries from such events as road traffic accidents, falls and assaults


• cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])


• elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy


• emergency surgeries, such as bowel perforation and neurosurgery


• neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage


• respiratory disorders, such as acute respiratory failure and pulmonary embolism


• GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure


• renal disorders, such as acute and chronic renal failure


• cancers, such as lung, oesophageal and gastric cancer


• shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

• adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients


• coronary care units


• cardiothoracic/neurosurgical/burns/liver units


• accident and emergency departments


• postanaesthesia/postoperative care units


• general wards as part of an 'outreach' team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).

Critical Care Nursing Career Tips

Critical care nursing is the specialty within the nursing profession that ensures the delivery of optimal care to acutely and critically ill patients. Critically ill patients are patients who are at high risk for actual or potential life threatening health problems. These patients are highly vulnerable, unstable, and have complex healthcare needs that require vigilant and intense nursing care.

These types of nurses and nurse practitioners are essential in intensive care units (ICUs), including medical, surgical, pediatric and neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. Critical care nurses are also part of medical evacuation and transport teams.

In the United States, most critical care nurses are registered nurses; because of the unpredictable nature of the patient population, licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) rarely assume the primary care role in caring for critically ill patients.

Registered nurses can obtain certification in critical care nursing through the American Association of Critical Care Nurses (AACCN), an advisory board that sets and maintains standards for critical care nurses. This certification, known as the CCRN, describes the holder as a certified critical care nurse for adult, pediatric and neonatal patient populations.

Several subspecialties of this type of nursing can be found in units composed of similarly aged patients. These subspecialties are in the following areas:

• Neonatal Intensive Care Unit, also called Nursery ICU or NICU. The NICU's patients are primarily newborn and premature infants who are cared for until they reach the gestational age of one month. After this period, their care will be assumed by the Pediatric Intensive Care unit.
• Pediatric Intensive Care Unit, or PICU. Here, the patients are about one month to eighteen years of age.
• Adult Intensive Care, or ICU, takes care of patients who are beyond eighteen.

There may, however, be deviations from the above setup, such as sending newborns who get admitted in the Emergency Department to the PICU, rather than the NICU. There may be rare cases where an adult patient with congenital heart disease will be admitted to the PICU, as their current treatment is a continuation of treatment they had been receiving from their physicians since they were children.

Care subspecialties may also be based on the type of disorder, disease or primary injury of the patient population. For example, the Adult Intensive Care Unit may have a specialized unit for trauma patients called the Adult Trauma Intensive Care Unit.

There is a variety of equipment used in the critical setting with which intensive care nurses need to be thoroughly familiar. These include hemodynamic and cardiac monitoring systems, mechanical ventilator therapy, intro-aortic balloon pumps, ventricular assist devices, continuous renal replacement equipment, and other advanced life support devices. All of these are at the critical care nurse's disposal when providing medical intervention to the critically ill.

With advances in healthcare and technology, medical conditions previously described as critical can now be treated outside the critical units. Nonetheless. critical care nurses continue to keep abreast with new treatment methods and technologies in this growing profession.

Why Critical Care is So Important

Critical care is an area of medicine that deals with the life-support and care of patients that are critically ill. Normally if you hear doctors refer to a patient as being in critical care, they are basically saying that the patient is in intensive care. The medicines that are administered in critical care are also intensive care medicines. This kind of service was established in different hospitals to ensure that you and the ones you love will be well taken cared of in times of emergency. The critical care service may not seem that important to you now until you are in a position where you or a member of your family is in desperate need of this service. Nevertheless, being aware that this service is available to you will make you feel a lot more comfortable, if you were to find yourself in an unfortunate emergency health situation.

It is very important that medical critical care services be available for 24 hours every day, as there are many people, probably thousands that may require this service on a day to day basis. It is highly recommended that you have a medical care service on call, if you are looking after members of your family that are diagnosed with diseases which make them susceptible to strokes, heart attacks or any other disease that is life threatening. In addition, in the case of pregnant women, these services can provide the much needed help if a delicate emergency delivery of the baby were to take place. This kind of service would also ensure that the necessary health care is given if any complications were to be developed at the time, or during delivery.

Critical care service would also be the best chance you have at getting emergency health care, if you were to develop or experience any severe medical complications in your body. This is because this service would ensure that intensive care is given to you by the medical staff as quickly as possible. In addition, there is no other medical service available that would be able to let you recover as quickly and safely as the service provided by critical care.

However, in order to be considered for the critical care services, your injury or illness, must meet the definition of a critically ill or injured individual. A person who is critically ill or injured is in a state that will harm one or more than one, of their vital organ systems, for example the respiratory system. The harm being done in this case to your vital organ system, must also be considered to be life threatening or a situation that will definitely result in your condition getting worse. If your injury or illness, meets the conditions above, then the critical care service would be administered to you.

If it so happens that you have to go to the critical care unit one day, there will be a team of doctors who will administer the necessary critical care service. They will perform critical services that will involve very complex decisions to control, assess, and support the operations of your vital organ system, and your organ system failure will be treated. These doctors will also carry out the necessary measures to ensure that your situation does not deteriorate any further, thus saving your life or the life of a member of your family.

The Ins and Outs of the Critical Care Nursing Field

Whenever the term critical care is mentioned - most people immediately think about severely sick patients in intensive care units or ICUs. They are not mistaken. Intensive Care Units and Critical Care specialized areas in the hospital that care for patients in need of intense and one on one attention. These are the areas where a critical care nurse Practices.

What is a Critical Care Nurse

A Critical Care Nurse or a CCN is a highly specialized nurse that has been trained to work in Intensive Care areas. They are nurses that care for patients who are severely ill and in need of individualized care. A CCN cares for patients of all diagnoses and gender. Patients may vary depending on this category. Critical care nurses also deal with complex technology that helps sustain patients.

The History

This type of nursing is a relatively new nursing specialty. It wasn't until the 1950's that the very first Intensive Care Units appeared in the Western world. These units were created to deal with gravely ill patients. They were considered to need a more intensive form of care compared to the patients in the regular wards. The notion of an intensive care unit quickly spread. Today, most hospitals are required to have these specialized areas and in turn specialized nurses and physicians to run them.

Back then, nurses assigned in CCUs and ICUs were not seen as different from regular ward RNs. It was only a few years later that CCN was considered as a specialized nursing field.

Roles of a CCN

Like any other registered nurse, the roles of the critical care nurse are very complex. These nurses have to deal with severely ill patients. They also need to be familiar with complex technologies that are continually present in a critical care setting. The critical care nurse also has to know basic and advance life support. Such skills may be called upon at any point during his/her service.

The critical care nurse must also be skilled in the art of diagnosis. He/she must be able to diagnose and identify a patient's immediate needs. This part of nursing is important as it may be the difference between life and death for a patient. Nonetheless, the nurse must remember that despite being skilled at diagnosis, one must not overstep her boundaries and perform roles reserved for a physician alone.

Aside from dealing with patients and their needs, the CCN also has to deal with the patient's family. The CCN often works as a counselor that helps the family get through the crisis at hand. He/she may have to deal with questions and concerns from the patient's immediate family and significant others.

Qualifications and Requirements

IN THE PHILIPPINES - Locally, any registered nurse can become a critical care nurse. It is only a matter of area assignment. Most of the time, nurses who are assigned in critical care units are those who have shown promise in their previous areas of exposure. They are also the ones who have worked in similar areas such as medical/surgical or pediatric units.

ABROAD - Abroad, in the US specifically, there are no specialized requirement to be a critical care nurse other than an RN License. However, there are bodies of authority that certify CCNs.

Although, certification is not required, most CCNs abroad are choosing to go for it because it increases their credibility. Employers also often require their CCNs to be certified in the field. Certification is achieved post graduation. It is not something taught in school. Some schools may expose their students to ICUs, but this is not considered enough for certification. The RNs get their CCN certificates while they are on the job. It is also often sponsored by the employer.

Work Opportunities in the Philippine Nursing Scene

There are a lot of opportunities to become a critical care nurse in the Philippines. But, nurses have to understand that these critical care units are often hard to get into. These units only require a limited number of nurses. Most of the time there are only a total of 12 nurses that work in a typical ICU with 8-10 beds.

Those who do get into these areas are considered lucky because their position opens great opportunities to work abroad. In most settings, CCNs have a lesser work load compared to nurses in large wards. Patients in ICUs need more attention but the numbers are much smaller compared to wards. A typical government hospital ward may hold 50-70 patients and with only a nurse or two to manage it.

Work Abroad

There are a lot of work opportunities for a critical care nurse abroad. The CCN can work in any area where there is an intensive care unit. Certification is often an option provided by employers to deserving and promising nurses. The employers are often the ones who fund certification seminars and the likes.

With the present shortage in nursing manpower, hospitals are clamoring to get their hands on specialized nurses. These employers would often offer big sign-in bonuses just to get a nurse to work with them. The average salary of a critical care nurse in the US often ranges from USD50,000 - USD 75,000. It is estimated that nearly 70% of the critical care nurse population earn that much. Some earn slightly lower while others earn upwards of USD90,000 to USD100,000 annually.

A Little Something About the Critical Care Unit

Critical caring medicine is used to provide life or organ support to patients who are critically ill or injured and require special monitoring. These patients normally suffer from respiratory or airway compromise, renal failure blood instability, or the effects of many organs failing. Patients who have not been stabilized to the point where they do not require intensive monitoring after a major are also given critical care.

This idea of critical caring has been developed as a crucial area of caring for a patient as medical technology and medicine advances. The critical care units first came after world war two to care for patients that required close monitoring and care. In those days, the patients that were most in need of care were located closest to the nursing station while the others were located further away. As a result, the patients were rotated constantly dependent on the need and the availability of beds.

Critical care nurses deal with the response of humans to life threatening traumas. To become a critical care nurse all that is required is for you to be a registered nurse (RN) and trained, obtaining a critical nursing certification is not a must. However, majority of the employers prefer nurses who have been certified in the field, as these nurses would have the skill and knowledge required for the job. To become certified a nurse must provide care for patients who are critically ill for at least 2 years and then they take the exam.

A critical care nurse is required to work under the nursing supervisor and care for the patients to which he or she has been assigned to. The tasks involves performing treatments, dispensing all medications and maintaining accurate and complete records for each patient. This nurse should be able to identify when a patient in critical care is experiencing complications, and be able to operate the different equipments in the critical care unit. This nurse is also required to help the doctors carry out procedures and treatments which is inclusive of sterile treatments.

It is recommended that each critical nurse be assigned 2 patients at most, however this may not be what happens in some hospitals depending on their staffing number. Hospitals in the United States can have up to 24% of the beds that are available for critical care patients. In this unit special and comprehensive care is provided 24/7. The rooms are built with glass walls to facilitate the constant supervision of the patients. In most cases the unit may have specified visiting time, with the visitors being restricted to family members only, so as to allow the staff to work at their optimum level without the influences from outside, compromising the care given.

Critical care doctors treat conditions that are threatening a patient's life, organ or limb. This area is a medical specialty because it is necessary to provide instantaneous diagnosis along with managing urgent aspects of the patient's injury or illness. Doctors in the unit must have a wide field of knowledge inclusive of trauma management, surgical skills, airway and cardiac life-support. The medicines used in critical care, include both general medicines and specialized medicines which are used to diagnose conditions and stabilize the patient.

How Do I Bill For Critical Care Services? What is Critical Care Service?

Critical Care is the direct care of the provider rendered to a critically ill or injured patient who requires exclusive attention of the physician. This means a full attention of the physician to the injured or critically ill patient.

Critical Care services will require full personal management by the physician. It is an intervention with life and vital organ systems' critical condition, life threatening and deterioration. It requires the physician's full assessment and manipulation to prevent further life threatening deterioration in the patient's condition.

Critical Care involves High Complexity in Medical Decision Making to assess and manage the life threatening, clinically impaired and injured patient. Vital organs such as but not limited to: central nervous system failure, circulatory system failure, shock, renal, hepatic, metabolic or respiratory system failure.

Critical Care is NOT necessarily rendered in the ICU or CCU. Critical care is always based on the patient's condition as described above. Therefore, a stable patient in an ICU or CCU is not always a critical care service.

The rendering physician must devote his full attention on the patient and must not be interrupted by seeing other patients.

99291 - Critical Care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

99292 - each additional 30 minutes (in conjunction with 99291)

The following procedures services are bundled in reporting Critical Care Services and are not billable during the critical care service provided on the same day by the same physician:

1. Interpretation of the Cardiac Output Measurements (93561, 93562)

2. Chest X-rays (71010, 71015, 71020)

3. Pulse Oximetry (94760, in computers ECGs, blood pressure, hematologic data (99090)

4. Gastric Intubation (43752, 91105)

5. Temporary Transcutaneous Pacing (92953)

6. Ventilatory Vascular Access Procedures (3600, 36410, 36415, 36540, 36600)

Medical Necessity Documentation:

Proper documentation must be recorded on the patient's records and proof of medical necessity why Critical Care Service is rendered.

Illustration on how to bill Critical Care Service:

Less than 30 minutes

Use the appropriate E/M Code

30 min to 1 hr and 14 min (30-74mins) - 99291 (1 unit)

1 hr 15 min to 1 hr 44 min (74-104 mins) - 99291 (1 unit)

+99292 (1 unit)

1 hr 45 min to 2 hr 44 min (105-134 mins) - 99291 (1 unit)

+99292 (2 units)

Modifier 25 and Modifier 24 can be used to bill with Critical Care Services codes (be guided with other procedures which are bundled with Critical Care Services - see above).

For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third party payer payment policies and guidelines