Wiki Critical Care and 31575 done in hospital

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wynonna

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Hello: 2 hours of critical care were provided in the hospital for inpatient. During that time, our provider did a laryngoscopy.
We billed: 99291-25, 99292 x 2 units, and 31575. (RVU for Critical Care is of course much higher than the laryngoscopy)
99292 x2 denied because:
"99292 is a non payable code/service when billed with the 31575 on same day. and Per HNE and CMS guidelines"
If we file a corrected claim, how would we rebill this?
thank you fellow coders.
 
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I found it!
Performing Bedside Procedures the Same Day as Critical Care
When performing bedside procedures on the same day as critical care, make certain that the procedure is not included in the time reported for critical care. For example, if you are placing a Swan-Ganz catheter (93503), which is not included in critical care, it can be reported separately. In order to get paid for the procedure, you must report the critical care service with modifier 25 to alert the payer that the E/M service is significantly and separately identifiable from the procedure. Here is an example of how to report the services. Total time of critical care services 105 minutes:
  • 99291-25 (30-74 minutes)
  • 99292-25 (each additional 30 minutes)
  • 93503 (insertion and placement of flow-directed catheter (e.g., Swan-Ganz) for monitoring purposes-- or 31575 in my example
  • From Society of Critical Care Medicine website
 
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