Creatinine (Blood): NCCI Bundling Denials - M80, CO-B15
Denial Reason, Reason/Remark Code(s)
• M-80: Not covered when performed during the same session/date as a previously processed service for the patient
• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• Example CPT code: 82565
unbundling
A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. The process of identifying and classifying the risk represented by an individual or group.
National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) packages or 'bundles' reimbursement for some services under Medicare. NCCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
Resources
• Check NCCI edits prior to claim submission; edits are updated quarterly. NCCI edits
• Use the NCCI tool to determine if the service you are submitting is bundled with another service
• CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with the following CPT codes: 80048, 80053, 80069 and 82575.
o For these combinations of services, CPT code 82565 is designated with indicator '1' in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.
Examples of separate, distinct services include tests that are performed different patient encounters. Supporting documentation is required in the medical records.
• For additional, specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 59).
Action :
If not Mutually inclusive CPT, We could resubmit the claim with Addition Modifier.
Some procedure not allowed during the time level period primary procedure, that case we should have write off the procedure. In future we should alert and not do the same service in that time period and perform the procedure once the time period is over. For Ex Home health services. certain procedure we cant perform that time period and it would be inclusive.
Anesthesia Services: Bundling Denials
Denial Reason, Reason/Remark Code(s)
B15 - Bundling: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
CPT code: 99100
Resolution/Resources
This code is listed as 'Status B' in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule
Denial Reason, Reason/Remark Code(s)
• M-80: Not covered when performed during the same session/date as a previously processed service for the patient
• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• Example CPT code: 82565
unbundling
A coding inconsistency that involves separating a procedure into parts and charging for each part rather than using a single code for the entire procedure. The process of identifying and classifying the risk represented by an individual or group.
National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) packages or 'bundles' reimbursement for some services under Medicare. NCCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
Resources
• Check NCCI edits prior to claim submission; edits are updated quarterly. NCCI edits
• Use the NCCI tool to determine if the service you are submitting is bundled with another service
• CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with the following CPT codes: 80048, 80053, 80069 and 82575.
o For these combinations of services, CPT code 82565 is designated with indicator '1' in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.
Examples of separate, distinct services include tests that are performed different patient encounters. Supporting documentation is required in the medical records.
• For additional, specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 59).
Action :
If not Mutually inclusive CPT, We could resubmit the claim with Addition Modifier.
Some procedure not allowed during the time level period primary procedure, that case we should have write off the procedure. In future we should alert and not do the same service in that time period and perform the procedure once the time period is over. For Ex Home health services. certain procedure we cant perform that time period and it would be inclusive.
Anesthesia Services: Bundling Denials
Denial Reason, Reason/Remark Code(s)
B15 - Bundling: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
CPT code: 99100
Resolution/Resources
This code is listed as 'Status B' in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule
we received b15 denial. However, we used 93923, 93923 with 59 attached on two separate lines. and per cms.gov fee schedule it states we can bill two. What are we doing wrong. I believe also there is a TC modifier attached as well
ReplyDelete