Wiki 99219, 93306

[amym]

We recently started receiving denials when we bill CPT 99219-25 (initial observation care) and 93306-26 (echo interpretation) on the same day as "unbundled". Is it appropriate for an insurance company to deny these two codes when billed same day? What logic can I use to appeal this?

 

[Jess1125]

We recently started receiving denials when we bill CPT 99219-25 (initial observation care) and 93306-26 (echo interpretation) on the same day as "unbundled". Is it appropriate for an insurance company to deny these two codes when billed same day? What logic can I use to appeal this?

No, this is not okay and I have our insurance department send a copy of the CPT E/M guidelines which state:

"The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician's interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code with modifier 26 appended"

You are not alone in these denials I'm finding.

Jessica CPC, CCC