New CCI edit

Hi,

I am working for a pain management physician. As per the new NCCI edits it states that injection procedures like 27096, 20610, 20605 etc., are inclusive with established office visit services 99211 - 99215. When we send some claims with the above combination we have received denial for 99213 stating as inclusive with the basic/primary procedure.

Anybody can help how to unbundle this.

Thanks in advance for cooperation.

Mike S.

re: New CCI edit

When billing an E/M service and an injection, the E/M must be medically necessary above and beyond the injection. If not, bill only injection. If there is medical necessity for an E/M unrelated to the injection, add modifier -25 to E/M and the diagnosis codes should reflect medical necessity for each service rendered.
If the CCI edit has a "0" indicator, you cannot bypass the edit.

re: New CCI edit

Are you reporting a -25 modifer and if appending modifier -25 does your documentation the guidelines? If you send me your email address, I will send you what I send to my team.

re: New CCI edit

Hi,

Thank you very much for your valuable response. I have sent the claim appending modifier 25 for the E&M service done on the same day of the injection, we have received a denial from Medicare stating "Procedure code incidental to primary procedure."

I have assigned a different diagnoses for the E&M what the patient has like 070.0, 496, 528.2, but still getting denial. As per the new CCI edits effective from 07/01/2013 they made a new rule that the E&M visits are bundled with injection procedures. It showing that we can bypass the edits by appending appropriate modifier, but not understanding what is the modifier to bypass.

Thanks,
Mike S.
mail ID - atm5@ace-data.org

re: New CCI edit

Try 59 on injection code