tci General Surgery Coding Alert - 2009 Issue 13

READER QUESTIONS: You Can Append 25 to Critical Care

Question: My surgeon performed critical care services and laceration repairs on the same day. I keep getting denials for the critical care. How should I code these services? Arizona Subscriber Answer: You need 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 (99291-+99292, Critical care, evaluation and management of the critically ill or critically injured patient ...) Critical care codes fall under the E/M section of the CPT manual. Without modifier 25, the payer will consider the E/M...

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