Wiki CT scans included with ED visit??

[tobeornottobeacoder]

I know this is probably a stupid question but I have to know. We have just started billing for an free standing ER and are getting a lot of denials for the CT scans done saying that they are included with the E/M visit. Is this correct???
If this is correct, why is that???

 

[mitchellde]

Who is telling you they are included?

 

[tobeornottobeacoder]

The payor is Scott and White in Texas. Every claim we have submitted to them with CT scans they are being denied as bundled but they will give us not information on why it is bundled which is very frustrating.

 

[mitchellde]

I have not ever had CT scans bundled with a visit. So there are many questions here. Such as is this work comp, or are you an FQHC, or Indian Health.

 

[tobeornottobeacoder]

This is just a free standing ER and are non contracted with any payers. They do not accept Medicare or Medicaid and dont fall under Indian, or FQHC. These are not Work Comp claims either. I dont get it. We are going to appeal these, but dont know how to proceed.

 

[mitchellde]

This is just a free standing ER and are non contracted with any payers. They do not accept Medicare or Medicaid and dont fall under Indian, or FQHC. These are not Work Comp claims either. I dont get it. We are going to appeal these, but dont know how to proceed.

I did billing for a freestanding ER and I remember there was a twist to it. What is the POS you are using? And do you have a trauma designation. Also are billing on a UB or a 1500 form or electronic equivalent.

 

[shellysk8]

Modifier?

Are you appending a modifier 25 on the ED code? I believe there is a CCI edit that bundles the CT scan into the ED code, so a modifier would be required in order to be reimbursed for both.