'Critical care is habit forming' -- so beware old risks, new red flags

by: Julia Kyles, CPC May 13, 2022

Expect increased medical review activity for critical care services (99291-99292). Confusion about the new rules opens the door to coding and billing errors and Medicare has created two new modifiers that will make it easier to pinpoint claims for audit.

There are also long-standing risks associated with these codes. For example, billing critical care services can be “habit forming,” writes Scott Kraft, CPMA, CPC, auditor for DoctorsManagement in his presentation for Critical Care 2022: Make Sure Your Medicare Claims Meet the New Coding and Billing Rules, a webinar that will take place Tuesday, May, 17, 2022, 1-2 pm, ET.

Here is a sampling of the risks and red flags – new and established – that Scott lays out in the presentation:

The division of labor for split/shared visits
Cloned notes.
Notes that don’t clearly show that the patient is critically ill.
Services that last for several days.
Conflicting time requirements.
Services performed by multiple providers from different specialties.

Scott will provide details and solutions on Tuesday, May 17.

This 60-minute webinar has been approved for 1 AAPC CEU and 1 BMSC CEU. Live attendees will fill out a short survey. People who listen to the on-demand recording must take and pass a 10-question quiz.

Blog Tags: CMS, compliance

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