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CPT 56501 included in E/m?

  1. Default CPT 56501 included in E/m?
    Medical Coding Books
    The CPT 56501 is bundling with 99213 even with the modifier 25. I can't seem to understand why this would be included in the e/m. Please help thank you

  2. #2
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    Quote Originally Posted by jhaleycoder View Post
    The CPT 56501 is bundling with 99213 even with the modifier 25. I can't seem to understand why this would be included in the e/m. Please help thank you
    Are you sure it's bundling to the E/M? It's not an NCCI edit, and even if it were, the 25 modifier wouldn't help here. Anytime you have a bundling denial, you need to add a modifier to the code that's being bundled into the other code, so in this case, if 56501 is really bundling into your E/M, you'd need to add a 59 modifier to it to get both processed - the E/M would only need a modifier if the denial was the other way around. (I've seen a lot of confusion on that - for some reason, whenever people see a bundling denial and an E/M is involved, the first assumption is that the E/M needs to get a 25 modifier, and that's not always the case...)

    Did you bill anything else that day?
    What does your EOB say?

  3. Default
    Okay thanks so much for the info.. The eob is saying Pymt included in allow for other service. it was billed with a 99213. I just figured why. It has 10 day global. needs a -58. I just started in primary care and they dont have any global tools or edits. Iam used to working in surgical coding. Now I need to see if the 99213 should of been billed but the pt did come in with asthma problems as well Thanks so much

  4. #4
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    Quote Originally Posted by jhaleycoder View Post
    Okay thanks so much for the info.. The eob is saying Pymt included in allow for other service. it was billed with a 99213. I just figured why. It has 10 day global. needs a -58. I just started in primary care and they dont have any global tools or edits. Iam used to working in surgical coding. Now I need to see if the 99213 should of been billed but the pt did come in with asthma problems as well Thanks so much
    It was in a global period for something else? You'd only need a global modifier if it was bundling into another procedure from a previous DOS. You may want to call and verify that it processed correctly - it sounds like it might have denied in error, honestly. Good luck!

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