Practice Management Alert

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 be coding 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 ...) you are reporting since critical care codes fall under the E/M section of the CPT manual. Without modifier 25, the payer will consider the E/M service related to the procedure your surgeon performed and will not pay you separately for the critical care. Remember: Critical care can occur wherever the physician performs critical care on a patient -- the patient does not need to be in the intensive care unit (ICU) or emergency [...]