Critical care on the same day as a procedure. Code 99291 is used for the first 30 to 74 minutes of critical care during a calendar day. The time need not be continuous. Code 99292 is used for each additional 30 minutes after the first 74 minutes. Frequently, critical-care services are rendered before or after a patient undergoes endoscopy to control gastrointestinal bleeding.
Most critical care is denied because of the diagnosis.
Modifier -25 may be used for a visit during which the decision is made to perform the procedure on the same day. Visits that are unrelated to the procedure, such as monitoring for unusually high blood pressure prior to the procedure, may be appended with modifier -25. When should we use modifier -25 vs. Many of the Medicare carriers still qualify modifier -57 as decision for major surgery. After discussions between our physicians and a consultant, we made a decision to stop billing for conscious sedation altogether.