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Thread: Bundled codes -urgent reply plz

  1. #1
    Join Date
    Apr 2007
    Tucson AZ

    Red face Bundled codes -urgent reply plz

    AAPC: Back to School
    I am getting mixed information. CCI edits say I can't bill 00740 for EGD under any circumstances. Nor can I bill 00810 for colonscopy "under any circumstances". There's also epidural 01967 not to be billed with 59400 "under any circumstances"

    I read thru this thread and find that people appear to be billing these anesthesia codes with those pro codes. Can ANYONE answer me for certain, what I can and can't bill? I'm very confused.

  2. #2
    Join Date
    Apr 2007


    As seen below the statement that might clarify the edits you are looking is this:

    "Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service."


    Below is from the link for the NCCI policy manual. The paragraph is found in chapter 1 on 19-20.

    So if you are billing for an anesthesiologist who is providing sedation for another physician performing a surgical procedure the edit would not apply.

    G. Anesthesia Service Included in the Surgical Procedure
    Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure. For example, separate payment is not allowed for the physician’s performance of local, regional, or most other anesthesia including nerve blocks if the physician also performs the medical or surgical procedure. However, Medicare allows separate reporting for moderate conscious sedation services (CPT codes 99143-99145) when provided by same physician performing a medical or surgical procedure except for those procedures listed in Appendix G of the CPT Manual.
    CPT codes describing anesthesia services (00100-01999) or services that are bundled into anesthesia should not be reported in addition to the surgical or medical procedure requiring the anesthesia services if performed by the same physician. Examples of improperly reported services that are bundled into the anesthesia service when anesthesia is provided by the physician performing the medical or surgical procedure include introduction of needle or intracatheter into a vein (CPT code 36000), venipuncture (CPT code 36410), intravenous infusion/injection
    Version 16.3
    (CPT codes 96360-96368, 96374-96376) or cardiac assessment (e.g., CPT codes 93000-93010, 93040-93042). However, if these services are not related to the delivery of an anesthetic agent, or are not an inherent component of the procedure or global service, they may be reported separately.

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