Ambulatory Coding & Payment Report
Reader Question: Services Bundled With Critical Care
Question: In the APC Final Rule (April 7, 2000, Federal Register, page 18450), CMS states, "If other services, such as surgery, x-rays, or cardiopulmonary resuscitation, were furnished on the same day as critical care services, we would allow the hospital to bill for them separately."
However, the CCI edits identify 71010 (chest x-ray) and 91105 (gastric intubation for treatment) as components of 99291 (critical care). In light of the statement above, these edits do not appear appropriate for hospital (technical) billing because it appears that reimbursement for these services is not bundled into the APC payment rate for 99291. Should hospitals add modifier -59 to 71010 and 91105 when these services are performed with 99291?
Kansas Subscriber
Answer: No. In this case, append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99291. You should list all of the procedures that are performed. Modifier -59 (distinct procedural service) is not necessary.
- Published on 2001-10-01
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