# E and M and Echos incental together



## lpick (Nov 16, 2011)

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...


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## Jess1125 (Nov 16, 2011)

lpick said:


> 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


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## dclark7 (Nov 16, 2011)

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


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## Lisa Bledsoe (Nov 21, 2011)

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.


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## krisfelty (Nov 21, 2011)

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


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## Jess1125 (Nov 21, 2011)

Lisa Bledsoe said:


> 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


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## Lisa Bledsoe (Nov 28, 2011)

Jess1125 said:


> 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.


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## efuhrmann (Nov 28, 2011)

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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