SCCM Resource Library-CMS Rule Changes for Critical Care Services in 2022

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The Centers for Medicare and Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule, introducing significant updates, particularly for split/shared visits in critical care within facility settings. Previously, CMS did not permit split/shared visits, but as of January 1, 2022, these are now allowed. A split/shared visit involves a physician and an advanced practice provider (APP) from the same group both participating in patient care. Only one practitioner, determined by who delivers the substantive portion of care (more than half the total time), can bill for the entire service. For critical care services, time alone dictates the determination of the substantive portion.<br /><br />A new modifier, FS-split (or shared) E/M visit, should be appended when hospital E/M services are split/shared. CMS adopted the Current Procedural Terminology (CPT) for defining critical care, which includes direct provision of complex medical care by qualified health professionals for critically ill patients. Certain services, like cardiac output measurements and ventilator management, are bundled into critical care time, precluding separate billing.<br /><br />Concurrent critical care by practitioners of different specialties is permissible if the services are non-duplicative and medically necessary. Practitioners of the same specialty can aggregate time to meet billing requirements if they provide care under the same calendar date.<br /><br />Critical care can be billed alongside other E/M services on the same day by the same or different practitioners within the same group if they occur before the critical situation arises. The CMS has introduced the FT modifier for unrelated E/M visits during post-operative or global surgical periods.<br /><br />Overall, the document outlines the new rules and provides clear guidelines for billing and documentation, ensuring practitioners effectively utilize the updated CMS rules for critical care services.

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Administration, 2022, 00:08:51

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This article was first published in the Winter 2022 issue of Critical Connections. The Centers for Medicare and Medicaid Services 2022 Medicare Physician Fee Schedule has been released, with many changes. One important change involves the guidelines for critical care services and split/shared visits in the facility setting. Author: Deborah Grider, CDIP, CCS-P, CPC, CPC-I, CPC-P, COC, CEMC, CPMA Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.

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Content Type Article

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

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Tag Economics

Year 2022

Keywords

CMS

Medicare Physician Fee Schedule

split/shared visits

critical care

facility settings

advanced practice provider

substantive portion

FS modifier

CPT

billing guidelines

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