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99152 bundling denials

Melissa Posted Wed 15th of February, 2017 15:02:51 PM
We are getting denials from Anthem on 99152 when billed with 64635. They say it is included with payment for 64635. I checked the CCI edits and there is no edit to suggest it is bundled. What am I missing
SuperCoder Answered Thu 16th of February, 2017 01:46:08 AM

According to general coding guidelines for NCCI "Medicare allows separate reporting for moderate conscious sedation services (CPT codes 99151-99153) when provided by same physician performing a medical or surgical procedure." So, you can bill CPT code 99152 with CPT 64635. But if Anthem is denying this code, please get in touch with them and ask for the medical policy documenting the reason of denial.

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