Critical Care Service Rule: Update for Surgery Billing

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Critical Care Service Rule Update for Surgery
Billing

• Defining Critical Care
• Under CY 2022 Medicare physician fee schedule
  final rule, effective from January 1, 2022,
  critical care services can be billed as
  split/shared services. Before discussing the
  crucial care service rule, lets define critical
  care services the direct delivery by the
  physician or other QHP of medical care for a
  critically ill/ injured patient in which there is
  acute impairment of one or more vital organ
  systems, such that there is a probability of
  imminent or life-threatening deterioration of the
  patients conditions. It involves high-complexity
  decision-making to treat single or multiple vital
  organ system failures and/or prevent further
  life-threatening deterioration of the patients
  conditions.
• When to use critical care codes
• For the critically ill or unstable patient with a
  high probability of imminent or life-threatening
  deterioration
• For critical care service 30 minutes or greater
• The physician provides their full attention
  cannot provide services to another patient at the
  same time
• Total time spent on treatment of the patient
  should be documented constant bedside attendance
  not required

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Critical Care Service Rule Update for Surgery
Billing

• When not to use critical care codes
• Patients who are in the postoperative global
  period and the critical care is related to the
  surgery
• When critical care services do not equal or
  exceed 30 minutes Report subsequent hospital
  care E/M code
• Patients in the ICU or critical care unit who do
  not meet critical care requirements Report as
  subsequent hospital care if unrelated to the
  global procedure
• Split (or Shared) Critical Care Visits
• Previous critical care rule critical care
  services could not be billed as split/shared
  services. Effective from January 1, 2022,
  critical care services can be billed as
  split/shared services. Total critical care
  service time provided by a physician or NPP (same
  group/on the same calendar date) is summed. The
  practitioner who furnishes the substantive
  portion (gt50) of critical care time reports the
  service. Split/shared documentation requirements
  apply.
• Specifically, billing practitioner bills the
  initial service (CPT 99291) and any add-on
  codes(s) for additional time (CPT 99292). Also,
  the substantive portion for critical care
  services is defined as more than half of the
  total time spent by physician and NPP beginning
  January 1, 2022. In the context of critical care,
  split (or shared)

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Critical Care Service Rule Update for Surgery
Billing
visits occur when the total critical care service
time furnished by a physician and NPP in the same
group on a given calendar date to a patient is
summed, and the practitioner who furnishes the
substantive portion of the cumulative critical
care time reports the critical care
service(s). When critical care services are
furnished as a split (or shared) visit, the
substantive portion is defined as more than half
the cumulative total time in qualifying
activities that are included in CPT codes 99291
and 99292. Since, unlike other types of E/M
visits, critical care services can include
additional activities that are bundled into the
critical care visits code(s), there is a unique
listing of qualifying activities for split (or
shared) critical care. These qualifying
activities are described in the prefatory
language for critical care services in the CPT
Codebook. Critical Care Visits during a Surgical
Global Period Critical care may be separately
reported during a global surgical period and
billed if the critical care service is unrelated
to the procedure. Preoperative and/or
postoperative critical care can be paid in
addition to the procedure if
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Critical Care Service Rule Update for Surgery
Billing

• The patient is critically ill and
• The patient requires the full attention of the
  physician and
• Critical care is unrelated to the specific
  anatomic injury or general surgical procedure
  performed (e.g., trauma, burn cases)
• While billing Medicare, the new modifier FT must
  be appended to the critical care services
  provided during a global period, no matter who is
  reporting the critical care. Modifier FT is
  defined as an unrelated E/M visit during a
  postoperative period, or on the same day as a
  procedure or another E/M visit. (Report when an
  E/M visit is furnished within the global period
  but is unrelated, or when one or more additional
  E/M visits furnished on the same day are
  unrelated). Modifier FT should be now appended to
  the CPT codes 99291 and 99292 instead of
  modifiers 24 and 25 when critical care is
  provided within the global period procedure that
  is unrelated to the global service.
• Documenting Critical Care
• Documentation must indicate the total time spent
  by each reporting practitioner. Indicate that the
  services furnished to the patient where medically
  reasonable and necessary for the diagnosis or
  treatment of the patients critical care
  illness/injury. Modifier FT must be appended to
  critical care services provided during

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Critical Care Service Rule Update for Surgery
Billing
the global period. For concurrent care, indicate
the role each practitioner played in the
patients care (i.e., the conditions for which
the practitioner treated the patient). Medical
Billers and Coders (MBC) is a leading medical
billing company providing complete revenue cycle
services. We hope you got a basic understating of
the critical care service rules. We shared this
billing information for provider education,
physicians are expected to understand payer
policies and members medical benefits plans. In
case of any assistance required in medical
billing and coding, email us at info_at_medicalbille
rsandcoders.com or call us at 888-357-3226. Refe
rence Critical Care Services