AAPC - Back to school
Results 1 to 3 of 3

Thread: Critical Care

  1. #1

    Red face Critical Care

    AAPC: Back to School

    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!

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default What modifier(s) did you use?

    What modifier(s) did you use?

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Nashville AAPC Chapter

    Default 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?

Similar Threads

  1. E&M Critical Care and Subsequent Hospital Care
    By abbyakinleye in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 04-10-2016, 01:51 PM
  2. Replies: 2
    Last Post: 05-18-2012, 04:01 PM
  3. Replies: 11
    Last Post: 02-21-2011, 11:06 AM
  4. Replies: 4
    Last Post: 10-19-2010, 09:37 AM
  5. Newborn Care and Neonate/Pediatric Critical Care
    By bobbro in forum Pediatrics
    Replies: 1
    Last Post: 03-03-2009, 03:35 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.