Wiki Critical Care E/M Coding use of modifiers

[LoreenAtkinson]

Hi, I've been using modifier 25 and 57 upon admit when someone has needed emergent surgery of some kind. Also I have been using modifier 25 for critical care time when pts have been seen, evaluated and then D/C. I'm concerning that the later use of this modifier is incorrect. What are the proper uses of modifier 25 when appropriately coding for these services? Thanks so much!

 

[FTessaBartels]

I can't tell from your post

I really cannot tell from your post whether you are using the correct codes and/or correct modifiers.

Just because a patient requires emergent surgery does not mean the patient is critically ill and that the physician is providing critical care. (e.g. appendectomy is considered emergent surgery, but the patient is rarely critically ill; and the care provided is not typically critical care)

If a patient is seen, evaluated and D/C I find it hard to believe the patient is critically ill and the care provided was critical care. Yes, I can think of one or two examples, but in my 10+ years coding (including five spent coding ICU exclusively, I only saw TWO examples of this ... )

Yes, it is sometimes appropriate to use the -25 modifier (or the -57 modifier) on the critical care codes, just as it is sometimes appropriate to use these modifiers on any other E/M services.

But without seeing actual notes, I cannot tell what codes / modifiers are appropriate to a given circumstance.

Hope that helps.

F Tessa Bartels, CPC, CEMC