Neurosurgery Coding Alert

Question: My local Medicare payer has recently started denying critical care services, saying they are inclusive when billed with a procedure. Is this correct?


Utah Subscriber


Answer: No, your payer isn't correct.

When reporting critical care in the postoperative period, however, you should be sure to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the critical care code(s) to differentiate the critical care aspect of the surgeon's services from the services included in the global surgical package.

Your diagnosis coding should also reflect the separate nature of the critical care. Specifically, you should be able to cite "an ICD-9-CM code in the range 800.0 through 959.9 (except 930-939) which clearly indicates that the critical care was unrelated to the surgery," according to the Medicare Carrier's Manual, section 4822.

Because critical care services pay at a high rate, some insurers - regardless of whether you append 24 - will send prepayment audit letters asking for records to prove that the services for 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes [list separately in addition to code for primary service]) were indeed separate and provided according to the definition.

Make sure your physicians know that they need to dictate that they delivered "X amount of critical care time outside of separately billable procedures" on these charts. Certain carriers may be looking for that specific statement before they will pay for all the services on the claim.