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Cardiology Coding Alert

Reminder:

Refile Denied Same-Day E/M, Diagnostic Test Claims

Published on Wed Aug 01, 2001

In October 2000, version 6.3 of the national Correct Coding Initiative (CCI) added more than 50,000 edits involving E/M services and diagnostic tests performed on the same day. Providers were instructed to append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M service performed on the same day as a diagnostic test.
 
The new edits were not popular among cardiologists, who typically perform one or more diagnostic tests when evaluating patients. However, in January 2001, the edits were suspended, pending review by the Centers for Medicare & Medicaid Services (CMS, formerly HCFA).
 
Any claims that were denied following the introduction of version 6.3 may be refiled, according to CMS. Claims must be refiled within a year of the submission of the original submission. Because the edits became effective Oct. 1, 2000, the one-year deadline will soon arrive. Dont forget to refile claims made between Oct. 1, 2000, and Jan. 1, 2001, as soon as possible.
 
Note: Some Medicare carriers have not yet changed their software, which means they may require modifier -25 to be attached to E/M services performed alongside diagnostic tests even though the edits were suspended. Cardiologists should contact their Part B carriers to determine if modifier -25 is still required on such claims.

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