# Critical Care E/M Coding use of modifiers



## LoreenAtkinson (Mar 12, 2012)

Hi, I've been using modifier 25 and 57 upon admit when someone has needed emergent surgery of some kind. Also I have been using modifier 25 for critical care time when pts have been seen, evaluated and then D/C. I'm concerning that the later use of this modifier is incorrect. What are the proper uses of modifier 25 when appropriately coding for these services? Thanks so much!


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## FTessaBartels (Mar 13, 2012)

*I can't tell from your post*

I really cannot tell from your post whether you are using the correct codes and/or correct modifiers.

Just because a patient requires emergent surgery does *not *mean the patient is critically ill and that the physician is providing critical care.  (e.g. appendectomy is considered emergent surgery, but the patient is rarely critically ill; and the care provided is *not* typically critical care)

If a patient is seen, evaluated and D/C I find it hard to believe the patient is critically ill and the care provided was critical care.  Yes, I can think of one or two examples, but in my 10+ years coding (including five spent coding ICU exclusively, I only saw TWO examples of this ... )

Yes, it is *sometimes* appropriate to use the -25 modifier (or the -57 modifier) on the critical care codes, just as it is sometimes appropriate to use these modifiers on *any other E/M* services.   

But without seeing actual notes, I cannot tell what codes / modifiers are appropriate to a given circumstance.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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