Neurosurgery Coding Alert

In October 2000, version 6.3 of the national Correct Coding Initiative (CCI) added more than 50,000 edits bundling E/M services to diagnostic tests performed on the same day. To receive separate payment, providers were instructed to attach 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 code filed on the same date of service as a diagnostic test, e.g., 62284 -- myelography. As a basis for this policy, CMS reasoned that Because every procedure has an inherent E/M component, for an E/M service to be paid separately, a significant, separately identifiable service would need to be documented in the medical record.
 
In February 2001, CMS said the edits would be suspended retroactively (memorandum B-01-09, Change Request 1546) and advised providers to resubmit any claims denied because of the edits. It continued to recommend that modifier -25 be appended to the E/M service code. Such claims must be resubmitted within a year of submission of the effective date of the 6.3 CCI edits. Because the edits became effective Oct. 1, 2000, the one-year deadline is fast arriving. Dont forget to resubmit your denied claims for payment as soon as possible.