Unrelated critical care evaluation and management (E/M) visit during a postoperative period, or on the same day as a procedure or another E/M visit.

Instructions

This modifier is used to report a critical care E/M visit during the global period of a procedure is not related to the operative procedure.

Correct Use

• Critical care requires full attention of the physician, and the critical care is above and beyond, and unrelated to the specific anatomic injury or general surgical procedure performed.
• Critical care services reported on same day as another E/M visit must be provided after the initial E/M service, and before the patient required critical care.
• When critical care is unrelated, append modifier to critical care service.
• Documentation supports medically reasonable and necessary service for the diagnosis and treatment of illness or injury to improve the functioning of a malformed body member.

Incorrect Use

• Critical care is during a global period and is related to the operative procedure.
• Critical care was performed prior to another E/M service on the same day.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Sections 30.6.12