General Surgery Coding Alert

Question: My practice has a heavy trauma volume and manages critical care issues for patients whom I have operated on. Can I use critical care codes? If another physician is also using a critical care code on the same day for that patient, can we both use the same code?

Florida Subscriber

 
Answer: Medicare and most private payers will usually pay only one physician for critical care services (99291-99292) administered to a given patient per day. Unfortunately, it is on a first-come, first-served basis. But two physicians critical care charges may be allowed on appeal, with proper documentation, if the physicians bedside presence was required because of a patients unstable condition and all other requirements of critical care, as specified by CPT, have been met and documented. Just because a patient is in a critical care ward, for instance, does not mean that he requires critical care as defined by CPT.
 
The surgeon would be able to charge only for critical care services if the care provided was unrelated to surgery that he or she previously provided (that is, if the care is administered during the global period of a previous procedure). If, for example, the patient had multiple traumas for which the physician performed emergency surgery, you would have to provide detailed documentation to justify that the critical care was unrelated to the surgery (which would be difficult
to establish).
 
The surgeon should state clearly what time was spent on postoperative care and on critical care services that day rather than total time spent. Medicare requires that you document this time separately.
 
The surgeon must append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to any critical care codes reported to indicate that they were separate and distinct E/M services provided during a postoperative period.