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Thread: Need Help with Modifiers to use - Please Help!

  1. #1
    Join Date
    Apr 2007

    Default Need Help with Modifiers to use - Please Help!

    AAPC: Back to School
    Critical Care doctor billed:

    32422RT w/76942-26
    32422LT w/76942-26
    36556 w/76937-26

    Records support the Critical Care charge and records show all three procedures were done.

    Can anyone help clarify what modifiers would be needed since three procedures were done on the same day and US guidance used for all three?

    Thanks in advance!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default -25 modifier

    You need a -25 modifier on the E/M code.

    IMPORTANT NOTE: Your time spent in critical care CANNOT include time spent performing ANY of these procedures.

    IMPORTANT NOTE 2: If child is under age SIX you should use pediatric critical care codes 99475-99476 (depending on whether it's initial day or subsequent day).

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 03-05-2010 at 04:38 PM.

  3. #3
    Join Date
    Apr 2007


    This physicians Critical Care time/charge does not include procedures/time spent doing the procedures.
    This has been discussed with the physician and he knows Critical Care time is not to include procedure time. He documents correctly in this area.

    I know about the 25 modifier on the 99291... it is the procedures where I am not sure of what modifiers needs to be attached to them.

    Patient is not under age 5.

    Last edited by sassmile; 03-05-2010 at 02:12 PM.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Oops - I meant

    Oops - I meant if patient is age 5 but not yet age 6.

    F Tessa Bartels, CPC, CEMC

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