Health Information Management

Tip: Review claims with critical care

APCs Insider, November 16, 2012

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Each facility should review its current reporting practices for critical care (CPT 99291) and the ancillary services that were considered to be included prior to January 2011.

Coders and billers should report these services on a separate line item with a CPT code and charge to reflect the cost and the specific services provided to the ­individual patient.
 
Facilities should review exactly what is being reported on the claim and coming back on the remittance advice. Some claim scrubbers require the removal of a service if coders don't append a modifier, meaning the cost/charge is lost when the claim is finally submitted. If a facility is reporting the line item separately but without a modifier to indicate the service is separate and distinct from critical care, the line item should be allowed to pass through the scrubber edits.
 
The tip is adapted from “Ensure accurate reporting and coding of critical care” in the October Briefings on APCs.



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