By Stacie Norris, CCS-P, CPC, Director, Coding Quality Assurance
The 2022 Medicare Physician Fee Schedule (MPFS) Final Rule contained some significant changes to the Medicare guidelines on Critical Care coding and billing. The CPT codes for Critical Care services are as follows:
CMS changed their policy to be more in-line with CPT’s guidelines on Critical care and officially adopted many of the CPT Critical care guidelines. For example, CMS stated in the MPFS Final Rule that NPPs (non-physician practitioners) can also report Critical care services, which is in-line with CPT. CMS also adopted the CPT rule to report any situation where services extend from one day to the next:
Regarding critical care services crossing midnight, CPT guidance defines how a service is to be billed when the service extends across calendar dates. For continuous services that extend beyond midnight, the physician or NPP will report the total units of time provided continuously. Any disruption in the service, however, creates a new initial service. We are adopting this rule for critical care being furnished by a single physician or NPP when the critical care crosses midnight.
In addition to the above changes, CMS also included the following in the MPFS Final Rule:
Stay tuned for more critical care updates from Zotec Partners, especially as we continue to track and research MPFS and upcoming E/M code changes to the specialty in 2023.