Sujet(s)
Procédures de chirurgie cardiaque/économie , 14886/économie , Barème d'honoraires/économie , Remboursement par l'assurance maladie/économie , Classification internationale des maladies/économie , Medicare (USA)/économie , Soins postopératoires/économie , Chirurgiens/économie , Budgets , Procédures de chirurgie cardiaque/législation et jurisprudence , 14886/législation et jurisprudence , Barème d'honoraires/législation et jurisprudence , Réforme des soins de santé/économie , Dépenses de santé , Frais hospitaliers , Coûts hospitaliers , Humains , Remboursement par l'assurance maladie/législation et jurisprudence , Medicare (USA)/législation et jurisprudence , Processus politique , Soins postopératoires/législation et jurisprudence , Échelles de valeur relative , Chirurgiens/législation et jurisprudence , États-UnisSujet(s)
14886/économie , Réforme des soins de santé/législation et jurisprudence , Politique de santé/législation et jurisprudence , Remboursement par l'assurance maladie/législation et jurisprudence , Chirurgie thoracique/économie , Sujet âgé , 14886/tendances , Femelle , Prévision , Politique de santé/économie , Humains , Remboursement par l'assurance maladie/tendances , Mâle , 29918 , Processus politique , Chirurgie thoracique/tendances , États-UnisRÉSUMÉ
This article explores the rules and regulations from Current Procedural Terminology (CPT) code set and US Medicare and Medicaid Services (Medicare) regarding multiple physicians reporting critical care services during the global period. The article takes into account the critical care definitions, regulations, documentation requirements, and services each provider can report to Medicare. A clinical scenario based on literature supporting the types of complications and care that might typically be included in the post-operative period for a patient who is surgically treated for a type A aortic dissection was analyzed. It was determined that multiple physicians may provide critical care services to a single patient during the global period. The physician who performed the primary procedure cannot report critical care separately unless documentation supporting use of modifier 25 (significant, separately identifiable services) or 24 (unrelated services) supports that critical care is unrelated to the global period. Other physicians may report critical care services separately if specific criteria are met. To report critical care services to Medicare, the patient's condition must meet the Medicare definition of critical care and the physicians should generally represent different specialties providing different aspects of care to the critically ill or injured patient as defined by Medicare. There should be no overlap in time of services provided by each physician. Each physician's documentation should clearly support medical necessity with the diagnosis demonstrating the critical nature of the patients' illness, the total time spent providing critical care, the critical care service provided, and other contributing factors.