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E and M and Echos incental together

  1. #1
    Default E and M and Echos incental together
    Medical Coding Books
    I need EMERGENCY help. Tricare, BCBS and Cigna are denying E and M with echos per Claimcheck stating they are incental to eachother. We appealed one with BCBS but it was denied. Anyone having any of these issues???? This is new problem. PLEASE answer...

  2. #2
    Default
    Quote Originally Posted by lpick View Post
    I need EMERGENCY help. Tricare, BCBS and Cigna are denying E and M with echos per Claimcheck stating they are incental to eachother. We appealed one with BCBS but it was denied. Anyone having any of these issues???? This is new problem. PLEASE answer...
    Recently I was having this issue, too. I've been having these appealed with copies of CPT E/M guidelines. (There is a paragraph in particular which states that the performance/interpretation of diagnostic tests are NOT included in the levels of E/M services).

    I don't know if they are being paid or not after appeal of denial. I don't do the appeal. The insurance department staff takes care of it after I tell them to appeal and give them appropriate documentation.

    Jessica CPC, CCC

  3. #3
    Location
    Hartford, CT
    Posts
    723
    Default
    You could also send a copy of that section of the NCCI edits. I looked at them today and these codes are not isted together on the edits which means they are NOT bundled

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
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    Not all payers follow NCCI edits but create their own. With these payers in particular, it would be appropriate to add mod -25 to the e/m. Save yourself delayed payment and extra work on an appeal.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    Phoenix/Scottsdale
    Posts
    139
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    If your doctor does not interpret it, it cannot be paid separately. It is considered included in the E&M.

    K. Felty, CPC, CCC, CCVTC

  6. #6
    Default
    Quote Originally Posted by Lisa Bledsoe View Post
    Not all payers follow NCCI edits but create their own. With these payers in particular, it would be appropriate to add mod -25 to the e/m. Save yourself delayed payment and extra work on an appeal.
    Hate to say it but they are denied even with a -25 on an e/m. Even had one last week that was denied still even after an appeal. I think this has to do with certain insurance companies using McKesson bundling edits that are just plain not correct.

    Jessica CPC, CCC

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
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    Quote Originally Posted by Jess1125 View Post
    Hate to say it but they are denied even with a -25 on an e/m. Even had one last week that was denied still even after an appeal. I think this has to do with certain insurance companies using McKesson bundling edits that are just plain not correct.

    Jessica CPC, CCC

    I have not encountered a denial with modifier -25 on the e/m; but I agree that the McKesson edits are not correct.
    Lisa Bledsoe, CPC, CPMA

  8. Default
    Here's my 2 cents worth...in the CPT book(page 15) "all levels of subsequent hospital care include reviewing the medical record and reviewing the results of diagnostic studies". The 93306-26 denials I received were with subsequent hospital care codes.

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