ICU and CCU Care

These fees apply to the services of being in constant or periodic attendance during a one day period, to provide all aspects of care to patients in Intensive or Coronary Care Units designated by the DHCS. There are four levels of care depending upon the procedures performed: 

(a) Comprehensive Care - This is the service rendered by a physician who provides complete care (both Critical Care and Ventilatory Support) to Critical Care Area patients. Comprehensive Care fees are not payable for services rendered to stabilized patients in ICUs or patients admitted for ECG monitoring or observation alone. 

(b) Critical Care - This is the service rendered by a physician who provides all aspects of care to a Critical Care Area patient except Ventilatory Support. Critical Care fees are not payable for services rendered to stabilized patients in ICUs or patients admitted for ECG monitoring or observation alone. 

(c) Observatory Care - This is the service rendered to stable ICU or CCU patients without invasive monitoring and without assisted ventilation. 

(d) Ventilatory Support - This is the service provided by a physician other than the one claiming Critical Care. It includes management of the intubated airway, tracheal toilet by suction catheter with or without instillation, and supervision of mechanical ventilation of the critically ill patient. 

These are team fees which apply to physicians providing complete daily care and should be claimed by the physician in charge of the patient. The daily fee includes payment for the initial consultation, subsequent assessments, and the ongoing monitoring of the patient’s condition, including the following procedures as required:

(a) insertion of IVs, intraosseous, arterial and CVP lines,

(b) use of pressure infusion sets, 

(c) endotracheal intubation and tracheobronchial toilet, 

(d) insertion and maintenance of urinary catheters and nasogastric tubes, 

(e) securing and interpreting the results of laboratory tests, oximetry, arterial blood gas samples, 

(f) infusion or injection of pharmaceutical agents, and 

(g) intracranial pressure monitoring, interpretation and assessment 

The following services may be claimed in addition to the daily intensive care fee codes:

(a) insertion of Swan-Ganz catheter, 

(b) cardiopulmonary resuscitation, 

(c) insertion of transvenous pacemaker, 

(d) all services listed for renal dialysis, 

(e) electrical cardioversion,

(f) endotracheal intubation, when it is necessary to be rendered by a physician other than the physician in charge, and 

(g) insertion of ICP measuring device.

These fees may be claimed in the pre and post-operative period for patients receiving either Comprehensive, Critical, Ventilatory or Observatory Care.

If the patient is transferred to the ICU or CCU directly from the OR or the Recovery Room, second day rates apply. However, when the care required supercedes the normal postoperative care for the surgery performed, and the patient is transferred from the surgeon to the attending ICU/CCU physician, first day rates apply.

Physicians not part of the daily care team, whose additional expertise is required, may bill for each item of service performed, including Concurrent Care (fee code 51790).

When a patient’s care is transferred to a higher or lower level, second day rates for that level applies. However, in any one period of ICU/CCU care, first day rates for the highest level is payable for the date the patient transferred to that level. Only one first day rate is payable per ICU/CCU period.

When a patient is readmitted to the ICU/CCU within 48 hours of discharge, second day benefits apply. After 48 hours, first day benefits apply.

Consultation or other assessments are not payable on transfers out of the ICU or CCU to the physician who cared for the patient in the ICU or CCU. However, consultations or assessments consistent with Preamble definitions are payable to other physicians, including those in the same specialty as the ICU/CCU physician, who render subsequent care to the patient transferred out of the ICU or CCU.

All claims for ICU and CCU must contain the facility number of the hospital in which the service was provided.