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Thread: Critical Care 99291 w/ 99292

  1. #1

    Default Critical Care 99291 w/ 99292

    Hi all,

    Billed out 99291-25, 99292, 31622-59. All paid except the 99292, medicare stated this needs a modifier even with a zero global day procedure...???

    Very confused. Didn't think add-on's had modifiers

    Any help
    Thanks
    Lynn

  2. #2
    Join Date
    Apr 2007
    Location
    Charm City
    Posts
    7

    Default

    you need a modifier 25 on the 99292 in order for them to pay it.

  3. #3

    Default

    Yes, I agree with the -25 modifier. What you may be thinking about is the fact that add-on codes cannot carry a -51 modifier but they can be modified with other HCPCS Level I or II modifiers.

  4. #4

    Default

    Quote Originally Posted by bill2doc View Post
    Hi all,

    Billed out 99291-25, 99292, 31622-59. All paid except the 99292, medicare stated this needs a modifier even with a zero global day procedure...???

    Very confused. Didn't think add-on's had modifiers

    Any help
    Thanks
    Lynn

    Just an FYI per ACEP for billing facility ED charges:
    CPT 99292 As above in additional 30 minute increments. Record the TOTAL critical care time. The first 30-74 minutes equal code 99291. If used, additional 30 minute increments (beyond the first 74 minutes) are coded 99292. Medicare does not pay for code 99292 because it is considered packaged into 99291; however the services should be reported as appropriate.

  5. #5

    Default

    Thank you, I will try with -25

  6. #6
    Join Date
    Apr 2007
    Location
    Maryville
    Posts
    17

    Default

    Hi,
    I do critical care billing and this is how we would bill this:
    example:

    99291-25
    99292-25
    31622



    You would need modifer 25 on the 99292 also since there was a procedure in addition to the total critical care

    Hope this helps

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