Wiki critical care modifiers - We billed a 99291-25, 99292

[econnick]

We billed a 99291-25, 99292 and 36556 lt we were not paid for the 99292. When we called Medicare they stated that they needed a modifer on the 99292. I have been told to put on 22 on and I'm not sure that is approprite. I would appreciate any and all help.

 

[PURNIMA]

We need to add modifier 25 to both 99291 and 99292 when billing CC with other non-bundled procedure codes such as ET Intubation, CPR and CVP.

In this case, add modifier 25 to 99292 and sudmit the claim.

Please refer to ACEP and CMS site for guidance.

Hope this helps you,

Thank You,

Purnima S, CPC

 

[Debi Bailey]

We need to add modifier 25 to both 99291 and 99292 when billing CC with other non-bundled procedure codes such as ET Intubation, CPR and CVP.

In this case, add modifier 25 to 99292 and sudmit the claim.

Please refer to ACEP and CMS site for guidance.

Hope this helps you,

Thank You,

Purnima S, CPC

Thank you for the above information. Can you please help me with were to find this documentation on the ACEP or CMS site.

Debi B., CPC

 

[eadun2000]

Per ACEP guidelines found at www.acep.org/content.aspx?id=30428.... it states at the bottom of the page under 99291 that "Medicare does not pay for 99292 because it is considered packaged into 99291; however, the services should be reported as appropriate." Hope this helps.