Wiki Critical Care

[Love Coding!]

Hello,

Does anyone know the answer to this question?

If a patient was seen in the hospital for critical care (severe difficulty breathing) and an x-ray showed pulmonary edema, hypertension, blood pressure and was placed on hemodialysis at that time. The physician spent a total time of 70min.

1. The insurance paid for the hemodialysis and did not pay for the Critical Care, does anyone know why?

Thank you! Hope to hear your reply soon!

 

[FTessaBartels]

What modifier(s) did you use?

What modifier(s) did you use?

F Tessa Bartels, CPC, CEMC

 

[OCD_coder]

Critical Care with Hemodialysis

In the guidelines for hemodialysis (90925-90940) it clearly states that if an E/M service was provided that is seperate from the hemodialysis 90935-90940 a modifier 25 must be used.
From what you are saying the MD did critical care for the breathing issues for the E/M evaluation. Hemodyaliss includes evaluations within the CPT codes that is why they did not pay for the critical care.

Is it possible that you had a seperate diagnosis for the hemodyalisis that you should have linked it to on the claim?