SCCM Resource Library-Revisiting Modifier Use in Critical Care

Pdf Summary

The document discusses the critical role of modifiers in medical billing and coding, specifically in critical care settings. Modifiers are necessary to convey that a service or procedure has been altered by specific circumstances without changing its fundamental definition. They are essential for accurate reimbursement, especially when multiple services are provided on the same day.<br /><br />Modifier 25 is highlighted as one of the most controversial yet crucial, particularly in cases involving critical care and other nonbundled procedures on the same day. It is applied when a critical care service is a significant, separately identifiable evaluation and management (E/M) service beyond the standard care associated with any provided procedure. This modifier is often necessary for billing these services separately to payers like the Centers for Medicare & Medicaid Services (CMS).<br /><br />The FS modifier is used when an E/M service, such as critical care, is split or shared between a physician and a non-physician practitioner, often determining which practitioner should bill for the service based on who provides the substantive portion of care.<br /><br />Another important modifier, FT, is for unrelated E/M visits during a postoperative period or on the same day as a procedure. It is used to indicate that critical care services can be billed in addition to surgical procedures if they are unrelated and necessary due to critical conditions arising from the surgery.<br /><br />The document emphasizes the need for practitioners to understand these modifiers' applications, even if billing staff typically append them. Proper documentation and understanding of modifiers ensure the correct billing for complex medical services and aid in receiving appropriate reimbursement from payers.

Asset Subtitle

Administration, 2023, 0:06:33

Asset Caption

"This article was first published in the Summer 2023 issue of Critical Connections.

It is important to understand how modifiers play a key role in ensuring accurate reimbursement. The American Medical Association states that modifiers “indicate the service or procedure performed has been altered by some circumstance but not changed in its definition.” This article discusses modifiers typically used in the critical care environment.

Critical Connections, the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team."

Meta Tag

Content Type Article

Knowledge Area Administration

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Economics

Year 2023

Keywords

medical billing

coding

critical care

modifiers

Modifier 25

reimbursement

Centers for Medicare & Medicaid Services

FS modifier

FT modifier

documentation

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