All physicians, including those caring for patients who are critically ill, have a professional obligation to address pain and other symptoms causing patient distress. The effective management of symptoms not only serves the goal of comfort but is also associated with physiologic benefits, including reduction of myocardial oxygen consumption, synchrony with mechanical ventilatory support, and improved pulmonary function. For the patient who is critically ill, symptom assessments are frequent, and management may be particularly complex and time-consuming because of hemodynamic instability, organ dysfunction, delirium, anxiety, and the concurrent use of multiple other medications. Physicians use critical care codes to report the integration of symptom and delirium management with critical care management, including continuation or weaning from intensive care therapies. There must be clear documentation that the clinical activity involves the delivery of critical care to a patient who is critically ill or injured.