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DENIALS FOR BUNDLING OF EVALUATION AND MANAGEMENT CODES WITH XRAY CODES

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19moonr@gmail.com

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Tyrone, NM
WE ARE RECEIVING DENIALS STATING THAT EVALUATION AND MANAGEMENT CODES BUNDLE WITH X-RAY COES. WE HAVE NOT EXPERIENCED THIS UNTIL RECENTLY. DOES THIS SOUND CORRECT THAT THEY BUNDLE? I HAVE NOT HEARD ANYTHING ABOUT THIS
 
19Moon
Ahh billing Xray CPT should be related to a definitive dx code to support reason why pt. need a x ray. IIf pt just getting xray document Eva/Mnt shuld support it on same date, add modifier 25 then xay. But may need these clinical procedures on separate claims with radiologist, referring doctor/provider and dx and Xray CPT.
Should always bill xray with a coordinating reason. I hope this helps you.
Lady T
 
What are the diagnoses, X-Ray codes, and E/M levels being billed? Does your office bill for the global XR also (meaning you own the equipment and your doc is interpreting the XR)? I think I would want more specific info on the health plan (is it only one or many?), how many claims are you talking about (has anyone run data analytics on the #?), and the type of practice specialty your group is.
Having to append a 25 to an E/M just because an XR was done sounds insane. Then, if you do that, next thing you know you'll be hit with a modifier 25 audit or auto-denial because of increased utilization of modifier 25 for no reason. You can't just blanket append a 25 on everything for no reason.
 
We are getting this denial now also. From Humana Medicare Advantage plan. They are citing the NCCI Manual Radiology section that states any procedure with an XXX we should not be billing an E&M code. I attended the Decision Health Advanced specialty coding symposium and this question was asked of Margie Scalley Vaught. She stated that this section was intended for Procedures where the physician or other provider was providing the procedure and should not also be billing an E&M. She stated that Noridian explains this in detail. I have yet to find Noridian's explanation. Wondering if anyone else has found info explaining why a standard Xray is not the intent of the NCCI policy?
 
amyjph said:
What are the diagnoses, X-Ray codes, and E/M levels being billed? Does your office bill for the global XR also (meaning you own the equipment and your doc is interpreting the XR)? I think I would want more specific info on the health plan (is it only one or many?), how many claims are you talking about (has anyone run data analytics on the #?), and the type of practice specialty your group is.
Having to append a 25 to an E/M just because an XR was done sounds insane. Then, if you do that, next thing you know you'll be hit with a modifier 25 audit or auto-denial because of increased utilization of modifier 25 for no reason. You can't just blanket append a 25 on everything for no reason.
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Agree! Humana Medicaid is pulling this denial nonsense.
 
yvetteprater said:
Our office received 4 denials for this reason in the past week. All from UHC, has anyone tried to appeal this decision and what was your argument?
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UHC just released a policy update that they were requiring the submission of a separate x-ray report when billed with an E/M same day. I wonder if this is related. We haven't had any denials as of yet, but are trying to prepare for them. Maybe submitting the x-ray documentation with a cover letter that the x-ray interpretation was not used to level the E/M and therefor is separately billable will help? I'll be interested to see what others are doing. Good luck!
 
Sending additonal documenation will not help. Our practice is doing so and they are still adding TC and 26 modifiers themselves and paying at lower rates. UHC policy was updated 04/01/2026. 25 modifier is discussed in this but we have no tried yet, was hoping the documentation submitted would support billing globally.
If anyone discovers a correction to this, please share your wisdom.
 
MorganDodson34 said:
Sending additonal documenation will not help. Our practice is doing so and they are still adding TC and 26 modifiers themselves and paying at lower rates. UHC policy was updated 04/01/2026. 25 modifier is discussed in this but we have no tried yet, was hoping the documentation submitted would support billing globally.
If anyone discovers a correction to this, please share your wisdom.
Click to expand...
UHC is also automatically applying 26 & TC modifiers without requesting records, watch your payments!
 
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