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Thread: billing edits on CPT codes used with E/M level

  1. #1

    Default billing edits on CPT codes used with E/M level

    AAPC: Back to School
    Hello all! Our billing manager came to me with some edits on ERs that they are commonly seeing. The edits say that our E/M level is not indicated for separate reimbursement with injection/infusion CPT codes, ie: 96372, as well as EKGs, 93005. Should there be a modifier appended to the E/M levels on facility or physician side or on the procedure codes? Does it depend on the documentation as well? Thanks for any help on this, I have a folder of these edits with visits on hold that I am going through and we are wondering if anyone else is having these edits. Otherwise we may turn off this particular edit and see how we get paid and go from there.

    Katie, RHIT

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    what is the visit level and what does the doc support? you cannot bill a 99211.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    The E/M level was a 99283...


  4. #4


    I haven't pulled the charts that have these edits yet. So lets say that there is further documentation of more of a work-up, would a modifier be used? And on which E/M, the physician or facility side? Does this edit only pertain to office E/M codes? The ones I am looking into are all ER encounters, thanks!

  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    If documentation supports then use the 25 on the E&M on both the facility and physician side.

    Debra A. Mitchell, MSPH, CPC-H

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