Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
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AHA Coding Clinic® for HCPCS - 2005 Issue 3
The Auditor's Corner
Occasionally, in many facilities patients who are in the emergency department do not meet all the criteria for Critical Care but are identified as a Level V.
Many of these patients receive ventilation management, transcutaneous pacing, and cardiac output measurement.
With these cases it is sometimes confusing as to whether it would be allowable to bill the services provided separately or bill as critical care where the ventilation management, transcutaneous pacing and cardiac output measurement is inclusive in codes 99291-99292.
For physician billing, it is important to understand that critical care involves the direct delivery of medical care by...
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