tci ED Coding & Reimbursement Alert - 2005 Issue 5

Reader Questions: Document Critical Care Carefully

Question: My local Medicare payer has recently started denying critical care services, saying they are inclusive when billed with a procedure. The carrier sometimes pays only the intubation and discounts the rest of the visit. Should I report something differently?Utah Subscriber Answer: When billing critical care codes with procedure codes, be sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the critical care code. Some payers, regardless of whether you append -25, will send prepayment audit letters asking for records...

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