SCCM Resource Library-Surgery and Critical Care Coding

Pdf Summary

The provided document is from the Fall 2020 issue of "CriticalConnections," discussing critical care coding and reimbursement during a surgical procedure's global period—0, 10, or 90 days post-procedure. The document outlines the requirements for billing critical care separate from the surgical procedure, specifically under the Centers for Medicare & Medicaid Services (CMS) guidelines. It highlights that critical care services on the same day as a procedure, performed by the same physician, are not reimbursed unless the service is significantly beyond standard pre- and postoperative care.

Key points include:

1. <strong>CMS Billing Guidelines</strong>: Per CMS Publication 100-04, critical care can be billed separately if it is distinct from routine surgical care, requires constant physician presence, and is unrelated to the surgery or injury.

2. <strong>Trauma and Burns</strong>: In trauma and burn cases, surgeons trained in critical care can bill separately if the care is unrelated to the main injury or procedure.

3. <strong>Transfer of Care</strong>: When care is transferred to another provider, specific billing practices apply, notably modifiers indicating whether care is solely surgical or includes postoperative management.

4. <strong>Multiple Providers</strong>: Only one provider can bill for critical care at any given time. However, concurrent care is reimbursable but requires detailed documentation.

Billing for critical care involves strict documentation, including the patient's critical status, care unrelated to the surgery, clinician decision-making, and total time spent. The summary emphasizes adherence to Medicare's rules and effective documentation for billing critical care services within the global surgical period. It advises providers to minimize billing rejection by understanding guidelines, documenting care diligently, and ensuring care is clearly distinguishable from routine postoperative care.

Asset Subtitle

Administration, Procedures, 2020, 00:05:32

Asset Caption

This article was first published in the Fall 2020 issue of Critical Connections. Critical care and follow-on care policies vary among insurers and Medicare Administrative Contractors (MACs). Providers should follow the guidance of the insurer or MAC. This article does not constitute legal advice, and the provider is ultimately responsible for compliance with Medicare billing rules. Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.Deborah Grider, CPC, COC, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP David L. Carpenter, MAPS, PA-C, FCCM

Meta Tag

Content Type Article

Knowledge Area Administration

Knowledge Area Procedures

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Learning Pathway Billing and Documentation

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Economics

Tag Surgery

Year 2020

Keywords

Billing and Documentation

Critical care coding

Reimbursement

Global period

CMS guidelines

Billing practices

Trauma and burns

Transfer of care

Multiple providers

Documentation

Medicare rules

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