Wiki E/M plus procedue code??

Create Wiki
T

tobieforte

Networker
Messages
41
Location
New Orleans, La
Best answers
0
Hi,

I'm trying to bill an in patient hospital code of 99223 and a 32554, a thoracentesis, for the same date of service. I added the "25" modifier on the E/M charge but then I am given a note stating that "NCC issue with CCM modifier: 99223". Could anyone inform me of the changes with the E/M codes being billed with certain procedures?? Am I being given this note because a 32554 is being bundled with a 99223 or is it that I'm using a 25 mod on the 99223?? I tried looking on Novitas site and can't bring up anything that helps. I would appreciate a much imput as possible.
 
EM plus procedure code

CCI 19.2 edits have bundled a lot of the EM codes with procedures codes. Check you CCI edits.
 
Were you using the 99223 for a consult where the decision for surgery was being made? If so, you can use a 57 modifier can be used. If the decision for surgery had been prior to the date of the surgery then you can NOT bill an E/M on the same day of the procedure.
 
debgispert said:
Were you using the 99223 for a consult where the decision for surgery was being made? If so, you can use a 57 modifier can be used. If the decision for surgery had been prior to the date of the surgery then you can NOT bill an E/M on the same day of the procedure.
Click to expand...

CPT 32554 does not have a global period attached to it. 57 modifier would not apply.
 
I can't find them. I looked on the CMS/Novitas website but nothing seems to be what I need?? I even called Novitas for help and they had me write a question into Novitas which they have never answered.It seems as though they could not find them either. (It makes me feel stupid that I can't navigate the CMS site.) Should I look somewhere else?? Thanks for your reply to my question. Tobie
 
tobieforte said:
I can't find them. I looked on the CMS/Novitas website but nothing seems to be what I need?? I even called Novitas for help and they had me write a question into Novitas which they have never answered.It seems as though they could not find them either. (It makes me feel stupid that I can't navigate the CMS site.) Should I look somewhere else?? Thanks for your reply to my question. Tobie
Click to expand...

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
 
Per NCCI the two codes are bundled. However, a modifier is allowed. If documentation supports a separate identifiable EM service (which it likely does on an initial hospital visit), I would consider appealing the denial.
 
You must log in or register to reply here.
Top