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Wiki NCCI edits/ global question

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nlaaron

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Sumter, SC
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What do you do when a code pair is not on the NCCI edit list? Eg. 99283 and 93005.
Also, does the global period apply to facility coding? If a patient goes to the ED for a unrelated illness 2 days after a toe amputation, should a 79 modifier be used on the E&M? Thanks for any help.
 
First no global does not apply to the facility. Second the 79 modifier can never be used on an E&M code. You need to check and see if the 93005 is a status S or T procedure, if it is the you need a 25 on the E&M.
 
thank you very much. 93005 has a status indicator of Q1 which her CMS means that a separate APC payment based on oh PPS payment criteria will be made. :)
?
 
When I dont put the 25 modifier on the E&M when billed with 93005, the billers are getting edits.... I have said it wasnt needed, but they told me to put it on... :confused:
 
nlaaron said:
When I dont put the 25 modifier on the E&M when billed with 93005, the billers are getting edits.... I have said it wasnt needed, but they told me to put it on... :confused:
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we bill EKGs with E/Ms quite often and never add a -25 modifier to the E/M. We don't have any issues getting paid on the E/M and EKG
 
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