• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

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