Wiki Critical Care 99291 w/ 99292

[bill2doc]

Hi all,

Billed out 99291-25, 99292, 31622-59. All paid except the 99292, medicare stated this needs a modifier even with a zero global day procedure...???

Very confused. Didn't think add-on's had modifiers

Any help
Thanks
Lynn

 

[sealsh]

you need a modifier 25 on the 99292 in order for them to pay it.

 

[mkmuir]

Yes, I agree with the -25 modifier. What you may be thinking about is the fact that add-on codes cannot carry a -51 modifier but they can be modified with other HCPCS Level I or II modifiers.

 

[eadun2000]

Hi all,

Billed out 99291-25, 99292, 31622-59. All paid except the 99292, medicare stated this needs a modifier even with a zero global day procedure...???

Very confused. Didn't think add-on's had modifiers

Any help
Thanks
Lynn

Just an FYI per ACEP for billing facility ED charges:
CPT 99292 As above in additional 30 minute increments. Record the TOTAL critical care time. The first 30-74 minutes equal code 99291. If used, additional 30 minute increments (beyond the first 74 minutes) are coded 99292. Medicare does not pay for code 99292 because it is considered packaged into 99291; however the services should be reported as appropriate.

 

[bill2doc]

Thank you, I will try with -25

 

[13kpcpc]

Hi,
I do critical care billing and this is how we would bill this:
example:

99291-25
99292-25
31622



You would need modifer 25 on the 99292 also since there was a procedure in addition to the total critical care

Hope this helps