Eli's Rehab Report
Therapy Bundling
PDF
Wisconsin Subscriber
Answer: Hundreds of medicine and diagnostic test codes were bundled with E/M services in version 6.3 of the national Correct Coding Initiative (CCI). The edits were withdrawn three months later following an outcry by physicians and because the HCFA directive was not applied consistently across the country. Some carriers, however, have yet to remove the edit, which required that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to any E/M service billed during the same session as a modality or test, such as 97530 (therapeutic activities) and 97022 (whirlpool). Therefore, you may need to resubmit your E/M service with modifier -25. This indicates to the carrier that the E/M service provided was not simply a "premodality" evaluation, which would be included in the therapy code.
Eli's Rehab Report
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Therapy Bundling
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