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Facilities may report procedures and critical care codes separately

APCs Weekly Monitor, June 24, 2005

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Facilities may report procedures and critical care codes separately

QUESTION: An outside company codes all of our ED claims. However, when the company codes our facility's critical care services, it does not code the procedures listed in the CPT Manual that state they are a component of critical care.

I know that this is incorrect, but I cannot find a source to direct them to. I have spoken to our FI, but they have not been any help. Can you please supply the documentation to support this?

ANSWER: Your facility should separately code procedures and critical care codes. Medicare clarified this in a Question and Answer published on their Web site on September 12th, 2000, and addressed it again in a Frequently Asked Questions (FAQ) dated October 14th, 2003.

You can find the Q/A section of the CMS Web site here: http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php

Q. Critical care codes have excluded procedures that are not covered under the listed codes; can those codes, when appropriate documentation is present, be listed in addition to the critical care codes?

A. The edits for services excluded when critical care is billed relate to physician services. For example, Medicare does not pay a physician for reading an EKG while providing critical care. The hospital, however, incurs costs for the technical component of such tests and procedures. Therefore, we have removed the critical care edits from the CCI edits used within the OCE (September 12, 2000).

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