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NCCI edits

Erin Posted Mon 05th of November, 2012 17:52:01 PM

Many payers are bundling codes 99213 with 92504 in the office setting.
Medicare pays for both cocds. Where can I find the NCCI edit that will show me that the two codes are not bundled. Modifiers are not needed nor do they work.
Thank you
Vivian

SuperCoder Answered Mon 05th of November, 2012 19:05:51 PM

Vivian, I will email you the PDF showing no CCI edit on the codes. That being said, remember that 92504 is designated a separate procedure by CPT. Make sure you do not double dip on the EM and 92504 bullets. Meaning, count any finding, history once either toward the EM level or 92504 but never toward both. Further:

Microscope Isn't Separate for Follow-up
- Published on 2006-05-18

Question: An otolaryngologist in our group practice wants to report 92504 every time he looks into the patient's ear during the postoperative period, even if the patient does not have a new or different problem. In other words, he wants to report the binocular microscope for routine post-op follow-ups. Is this correct?

Answer: You should not report 92504 (Binocular microscopy [separate diagnostic procedure]) for routine post-op care. If the ENT is simply checking the ear during the global period of a previous procedure, use of the microscope is bundled to the primary procedure.

But if the ENT uses the microscope to check for a new or different problem, or to check the other ear, for instance, you may be able to report 92504 separately by appending modifier 59 (Distinct procedural service). Keep in mind that because 92504 is designated a -separate procedure- by CPT, you cannot report it in addition to any other services the ENT provides in the same area during the same session.

On the other hand, you may report a separate E/M service with 92504. You should maintain separate documentation to stress the distinct nature of the E/M service, and you should also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

Jen Godreau, CPC, CPMA, CPEDC

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