tci ED Coding & Reimbursement Alert - 2004 Issue 9

READER QUESTIONS: Walk Softly With Modifiers and Critical Care

Question: What are the guidelines for modifier use with critical care codes? For example, when the physician performed two hours of critical care, and we report 99291 and 99292, should we append modifiers? We don't report two units of 99292 because we've had too much trouble getting insurers to reimburse the second unit.Virginia Subscriber Answer: The modifier that comes into play most often with critically ill patients is -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), because these patients frequently require multiple procedures. For...

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