Gastroenterology Coding Alert

Question: Our gastroenterologist recently had to spend a lot of time and effort to control bleeding on a critically ill patient. Should I report the extra time and effort spent on the patient with a critical care code or with a modifier 22?Vermont SubscriberAnswer: To report the control of bleeding under the critical care services code, the condition of the patient must be critical as described in the guidelines laid down by CPT®. As per the CPT® guidelines, "critical care is the direct care provided by a physician to critically ill or injured patient" and "the critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition." CMS also states that "Critical care services must be medically necessary and reasonable". For more details, check http://www.cms.gov/manuals/downloads/clm104c12.pdf.If the condition of the patient satisfies the [...]