Critical care services:
- Many hospitalists often provide critical care to patients. Some hospitalists may not be aware that in order to charge the critical care they must provide certain documentation. If a patient has a critical diagnosis, if critical care criteria is met, and the hospitalist spends at least 30 minutes providing critical care (aside from any procedures the hospitalist conducted for the critical patient), then the hospitalist may charge for critical care.
- Critical care codes are time based; therefore, the hospitalist must attest or state that he or she provided critical care and note the total time spent providing critical care.
Discussion with other Provider:
- Discussion with other providers results in credit for a higher level of service. Hospitalists should clearly note all discussions with consult-providing doctors, as well as other providers who care for the patient. Simply stating a specialty (such as cardiology, urology, neurology etic,) is ‘on board’ is invalid and will not result in credit for discussion with other providers.
- A significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.
- It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
- Modifier 25 is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported
Modifier 54: Surgical care only.
- When one physician performs a surgical procedure and another provides pre-operative and/or post-operative management, surgical services can be identified by adding the modifier 54 to the procedure number.
Modifier 55: Postoperative management only.
- When one physician performs the post-operative management and another physician performs the surgical procedure, the post-operative component can be identified by adding the modifier 55 to the procedure number.
Modifier 56: Preoperative management only.
- When one physician performs the pre-operative care and evaluation and another physician performs the surgical procedure, the pre-operative component can be identified by adding the modifier 56 to the procedure number.
Modifier 57: Decision for surgery.
- E/M service resulting in the initial decision to perform the major surgery can be identified by adding the modifier 57 to the appropriate level of E/M service. Decisions for elective surgeries typically are made at a previous outpatient encounter. Do not append modifier 57 when this occurs.