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CCI Edits - I have a carrier disputing

  1. Default
    Medical Coding Books
    Thanks Brandi! I appreciate your help and willingness to share your knowledge!

  2. Default 99223 and 99232/99233
    Hi, new CCI edit states that no modifier is allowed when billing these codes. Not sure if this is correct. Here is the scenario:
    7-1-11 99223
    7-2-11 99232
    7-3-11 99232
    All for the same provider, same pt with the same diags.

    No other cpt/hcpcs codes billed and pt was not seen by other providers at all.

    Please assist. Thanks.

  3. #13
    Default
    Quote Originally Posted by SusanCabral@Ingenix.com View Post
    Hi, new CCI edit states that no modifier is allowed when billing these codes. Not sure if this is correct. Here is the scenario:
    7-1-11 99223
    7-2-11 99232
    7-3-11 99232
    All for the same provider, same pt with the same diags.

    No other cpt/hcpcs codes billed and pt was not seen by other providers at all.

    Please assist. Thanks.
    What I see here are inpatient codes for 3 different DOS, so CCI edits won't apply. Your denials could be caused by a couple of issues:
    1. These could be within a Surgical Global period - was a major procedure done by the same provider within the past 90 days? If so, you may need to see if the visits are eligible for separate reimbursement - if they're routine follow up to the surgery, then they're not, but if they're unrelated to the surgery, then bill with a 24 modifier.
    2. Has another provider of the same specialty seen the patient on these same service dates? If so, you may need to appeal with medical records showing that the providers were seeing the patient for different conditions.
    3. Is your patient enrolled in Hospice? You may have diagnoses that are conflicting with a Hospice diagnosis, if so.

    What denial is your EOB stating?

  4. Default
    Thanks. It was the Hospice claim. Have a great weekend!

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