Why does health care cost so much in the U.S. part the infinity

I'm on a lot of email lists thanks to my profession. A message I got today is below. I won't make you read it before I explain that one reason medical services cost so much in this godforsaken country is that providers have to hire people to with specialized training and pay them salaries to deal with this crap. Keep in mind that they see people with multiple different kinds of insurance and they need to keep track of what insurance the person has, what it will pay for, how much, and how, based on manuals containing hundreds of pages of similar dreck. And if they don't get it just right, they won't be paid. In civilized countries, this doesn't happen.

When billing CPT code 99292 when you deliver critical care as a split (or shared) visit, an important correction has been made by the Centers for Medicare and Medicaid Services effective March 3, 2023.

According to Section 30.6.12.5 in the Medicare Claims Processing (MCP) Manual (Chapter 12), CMS changed the number of cumulative total minutes from 75 to 104.

This correction made to the MCP is effective 01/01/2023 and implemented 03/03/2023.  Please share this information to you coding, auditing and billing professionals.

“…. To bill split (or shared) critical care services, the billing practitioner first reports CPT code 99291 and, if 104 or more cumulative total minutes are spent providing critical care, the billing practitioner reports one or more units of CPT code 99292. Modifier -FS (split or shared E/M visit) must be appended to the critical care CPT code(s) on the claim.

The same documentation rules apply for split (or shared) critical care visits as for other types of split (or shared) E/M visits. Consistent with all split/shared visits, when two or more practitioners spend time jointly meeting with or discussing the patient as part of a critical care service, the time can be counted only once for purposes of reporting the split (or shared) critical care visit.”

MCP Chapter 12 Section 30.6.12.8 provides guidance on critical care documentation requirements.  This section was last updated in 2022, however, reviewing this information will assist in coding, documentation and billing compliance.  A few salient points to remember are:

• Critical care is a time-based service;

• Practitioners must document in the medical record the total time (not necessarily start and stop times) that critical care services are furnished by each reporting practitioner;

• Documentation needs to indicate that the services furnished to the patient, including:
  • any concurrent care by the practitioner;
  • documentation of medical necessity for the diagnosis and/or treatment of illness and/or injury or to improve the functioning of a malformed body member

• Services must be sufficiently documented to determine the role each practitioner played in the patient’s care (that is, the condition or conditions for which the practitioner treated the patient) upon audit

When critical care services are reported the same date as another E/M visit, the medical record documentation must support:

1) that the other E/M visit was provided prior to the critical care services at a time when the patient did not require critical care,

2) that the services were medically necessary, and

3) that the services were separate and distinct, with no duplicative elements from the critical care services provided later on that date.

• Access Transmittal 11828 for more information
• Download the MCP Manual, Chapter 12 and reference 30.6.12.5 Split/Shared Critical Care Visits

March 20, 2023

Correction of Split/Shared Critical Care CMS Billing Requirement

Documentation & Billing Compliance Update