Can a provider submit critical care services and a procedure on the same calendar date? Can you add the time spent performing these separately billable services towards the critical care time?

Answer:
Critical care services must not be paid on the same calendar date the physician also reports a procedure code with a global surgical period unless the critical care is billed with CPT modifier 25 to indicate that the critical care is a significant, separately identifiable evaluation and management service that is above and beyond the usual pre- and post-operative care associated with the procedure that is performed.

Services such as endotracheal intubation (CPT code 31500) and the insertion and placement of a flow directed catheter, e.g., Swan-Ganz (CPT code 93503), are not bundled into the critical care codes. Therefore, separate payment may be made for critical care in addition to these services if the critical care was a significant, separately identifiable service and it was reported with CPT modifier 25. The time spent performing the pre-, intra-, and post-procedure work of these unbundled services, e.g., endotracheal intubation, must be excluded from the determination of the time spent providing critical care.

This policy applies to any procedure with a zero, 10 or 90 day global period including cardiopulmonary resuscitation (CPT code 92950). CPR has a global period of zero days and is not bundled into critical care codes. Therefore, critical care may be billed in addition to CPR if critical care was a significant, separately identifiable service and it was reported with CPT modifier 25. The time spent performing CPR must be excluded from the determination of the time spent providing critical care. In this instance it must be the physician who performs the resuscitation who bills for this service. Each member of a code team must not bill Medicare Part B for this service.

Resource: 100-04, Chapter 12, Section 30.6.12 K

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