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Observation of care 99219 billed with anesthesia code 00810

B

binateans

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7
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Atlanta/Perimeter
Can anyone provide me with the rationale behind the NCCI edits where cpt code 99219 (observation of care) and anesthesia code 00810 cannot be billed together with or without a modifier to differenciate between the two services.
 
I have a provider who insists on billing these two codes together. He is stating that he is billing 99219 with a modifier 25 because a history and physical were performed prior to the procedure. It seems a colonoscopy was performed in an ambulatory surgical center and he feels he should be able to bill for the e/m, the procedure and the anesthesia. Not only is the E/M service unbundled from the anesthesia but the anesthesia is also unbundled from the actual procedure. I am trying to provide him with the reason you can't bill this way other than saying it is an edit. Also, the colonoscopy has a global period of zero days which only includes the day of service but is included in the procedure. I just need a strong argument to present to him.

Thanks
 
CMS has several transmittals and memos regarding that you cannot charge for the E&M when the patient is comming in for the purpose of a colonoscopy. Certainly this does not meet the 25 modifier definition. We know the patient is comming for a colonoscopy, we know why we are doing it, we have the patient's relevant hx already, you do not have a visit that is significant(over above and beyound the reason for the diagnositc test) nor spearately identifiable. As far as the anesthesia goes unless your physician is the anesthesiologist then you cannot bill that code, the sedation for the colonoscopy is included.
Also observation codes are for use by the physician that has ordered observation care in an outpatient setting.
 
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