Critical Care Coding Expertise
Built for Accuracy & Compliance
Time-based ICU billing specialists ensuring compliant documentation, reduced denials, and optimized reimbursement.
Critical Care Coding Expertise | Pulmocare RCM
Critical Care Coding Expertise That Protects Revenue & Compliance
Pulmocare RCM delivers specialized Critical Care Coding and Billing Services for ICU physicians, pulmonary-critical care specialists, hospitalists, and inpatient care teams across the United States. With 27 years of experience, we ensure time-based critical care services are coded accurately, documented correctly, and reimbursed compliantly.
Pulmocare RCM specializes in critical care coding using CPT 99291 and 99292, supporting ICU physicians and pulmonary-critical care teams with compliant time-based billing, documentation audits, and denial reduction strategies.
Critical Care services are among the most scrutinized by payers. Time-based billing, overlapping provider rules, shared services, and documentation requirements can easily lead to denials or underpayment.
Pulmocare RCM’s team is trained extensively in ICU-specific billing and CMS critical care guidelines.
Why Pulmocare RCM for Critical Care Coding?
27 years of Pulmonary & Critical Care billing experience
Specialty-trained ICU coding professionals
Nationwide U.S. coverage
Deep CMS & payer guideline expertise
AI-enabled documentation audits
Transparent reporting and analytics
Proven denial reduction strategies
Pulmocare RCM’s Critical Care Expertise Covers:
- Time-based critical care services (99291, 99292)
- Split/shared critical care rules
- Concurrent care billing
- Organ failure management
- Ventilator support
- Sepsis & shock management
- Invasive procedures
- High-acuity patient management
- Daily ICU rounding
- Review of time statements
- Review for bundled procedures
- Documentation validation
- Support for “medical necessity” requirements
- Denial-proof coding structure
Critical Care billing leaves no room for error — and our team ensures you get every dollar you deserve.
Critical care claims are among the most audited and denied by payers due to:
- Time-based billing requirements
- Overlapping provider services
- Split/shared critical care rules
- Bundled procedures
- Medical necessity validation
- ICU documentation gaps
- Concurrent care conflicts
Even minor documentation errors can result in denials, downcoding, or recoupments.
Pulmocare RCM provides coding and billing expertise for:
- Initial critical care (99291)
- Additional critical care time (99292)
- ICU daily management
- Organ failure and life-threatening conditions
- Ventilator management (when not bundled)
- Sepsis, shock, and respiratory failure
- Invasive and non-invasive monitoring
- Emergency and inpatient ICU consultations
- Pulmonary-critical care overlap services
Every claim is reviewed for time accuracy and medical necessity.
We apply a multi-layer validation process to every critical care encounter:
- Verification of total documented time
- Review of time statements for CMS compliance
- Exclusion of separately billable procedures
- Validation of organ failure or life-threatening conditions
- Review for concurrent and split/shared services
- Payer-specific guideline checks
This proactive approach prevents denials before claims are submitted.
- 99291: First 30–74 minutes of critical care
- 99292: Each additional 30 minutes beyond the initial period
To bill these codes, documentation must clearly show:
- Total time spent
- Physician’s direct involvement
- Medical necessity
- Exclusion of procedure time
- No overlapping provider time
Pulmocare RCM audits all notes to ensure compliance.
Critical care billing becomes more complex when multiple providers are involved. Pulmocare RCM ensures:
- Proper attribution between physicians and APPs
- Compliance with CMS split/shared rules
- Accurate reporting of concurrent care
- Avoidance of duplicate or overlapping time
- Correct modifier usage
This protects reimbursement while maintaining compliance.
Most critical care denials stem from documentation—not medical necessity.
Pulmocare RCM reduces denials by:
- Reviewing ICU notes before submission
- Identifying missing time elements
- Ensuring organ system failure is documented
- Educating providers on compliant documentation
- Performing root-cause analysis on denied claims
This leads to fewer audits and faster payments.
What Is Critical Care Coding?
Critical care coding is the process of accurately documenting and coding medical services provided to patients with life-threatening or organ-failure conditions, where constant physician attention is required.
These services are billed using time-based CPT codes 99291 99292 and must meet strict CMS and payer documentation requirements.
Critical Care Coding FAQs
Critical care qualifies when a physician provides direct care to a patient with life-threatening or organ-failure conditions requiring constant attention, supported by detailed documentation and time tracking.
Critical care is billed using time-based CPT codes. We validate documented time, remove bundled procedures, ensure no overlap between providers, and confirm medical necessity before claim submission.
Common causes include missing time statements, insufficient documentation, overlapping provider time, incorrect bundling, and lack of medical necessity documentation.
Yes. We specialize in pulmonary-critical care overlap and ensure pulmonary services and critical care services are coded separately and compliantly.
Yes. We support ICU physicians, hospitalists, pulmonary-critical care specialists, and inpatient care teams nationwide.
Most critical care claims are submitted within 24–48 hours after complete documentation is received.
Yes. We follow strict HIPAA standards, including encrypted data handling, role-based access, secure systems, and regular audits.
Yes. Practices typically see 20–40% revenue improvement by preventing underbilling, reducing denials, and ensuring compliant time-based billing.
Protect Your Critical Care Revenue with Pulmocare RCM
Ensure compliant, accurate, and optimized critical care coding for ICU and inpatient services across the United States.
Schedule a Demo / Contact Us
Let us show you how our Pulmonary & Critical Care Billing expertise can transform your revenue performance.
