Wiki 93320 & 93325 denied-Can someone

[coders_rock!]

Can someone please help me understand? My doc is being denied payment for 93320 & 93325. All other codes were paid (93306,93350,93016,93018).

 

[jewlz0879]

Because 93320/93325 are both included within 93306. So you're billing a Echo and Stress Echo.

 

[coders_rock!]

Thanks for responding Julia.

I understand that CCI edit bundles 93320 into 93306 and no modifier is allowed to unbundle it, however, it allows a modifier for 93325. This is what confuses me.

Also, are you saying that if my doc is reporting 93320 and 93325, he should be using 93306 instead. Reporting 93320 & 93325 would be considered unbundling?

 

[leigh]

Tee?

Are you billing for TEE --- 93312-- 93320 and 93225? Thanks

 

[jewlz0879]

Ha! I never realized that, but you are correct, as per CCI 93325 is allowed with modifier. That is confusing. But the code description itself states 93306 includes all three components: 2D, Color-flow and Doppler.

If your physician is billing for an Echo, just a plain ole' Echo and he performs a complete echo as listed under 93306, then no, he should NOT be billing 93320/93325 in addition.

But you also have a Stress Echo. For a stress echo in the hospital you would bill: 93350. 93016, 93018 and 93320/93325, if performed.

Stress Echo in the office - 93351 (this code includes the stress portion), 93320/93325.

Personally, I do not think both of these should be billed. Did your physician do just a Echo or did he do a Stress Echo?

Per NCCI you can bill 93350/93306 with a modifier but your documentation will have to be solid and really illustrate medical necessity for both.

93350 93306 20090101 * 1


HTH