tci ED Coding & Reimbursement Alert - 2021 Issue Q1

Critical Care: Check This Primer to Understand When Modifiers Apply to Critical Care

Modifier 25 isn’t always billable, this expert says. When your ED specialists perform critical care, they are typically watching the clock to carefully calculate the minutes they’re performing lifesaving responsibilities. But if the documentation doesn’t include additional details, you may not be able to append modifiers to these claims. Auditors recently performed a review to determine how detailed critical care documentation has been, as part of a new comparative billing report (CBR) compiled by RELI Group, Inc., which CMS contracts to develop, produce, and distribute CBRs. CBRs are educational and comparative tools to help providers ensure...

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