# E/M plus procedue code??



## tobieforte (Jul 24, 2013)

Hi,

I'm trying to bill an in patient hospital code of 99223 and a 32554, a thoracentesis, for the same date of service.  I added the "25" modifier on the E/M charge but then I am given a note stating that "NCC issue with CCM modifier: 99223".  Could anyone inform me of the changes with the E/M codes being billed with certain procedures??  Am I being given this note because a 32554 is being bundled with a 99223 or is it that I'm using a 25 mod on the 99223??  I tried looking on Novitas site and can't bring up anything that helps.  I would appreciate a much imput as possible.


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## Monika Liddle (Jul 24, 2013)

*EM plus procedure code*

CCI 19.2 edits have bundled a lot of the EM codes with procedures codes. Check you CCI edits.


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## debgispert (Jul 24, 2013)

Were you using the 99223 for a consult where the decision for surgery was being made?  If so, you can use a 57 modifier can be used.  If the decision for surgery had been prior to the date of the surgery then you can NOT bill an E/M on the same day of the procedure.


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## RFoster1 (Jul 24, 2013)

debgispert said:


> Were you using the 99223 for a consult where the decision for surgery was being made?  If so, you can use a 57 modifier can be used.  If the decision for surgery had been prior to the date of the surgery then you can NOT bill an E/M on the same day of the procedure.



CPT 32554 does not have a global period attached to it.  57 modifier would not apply.


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## tobieforte (Jul 24, 2013)

I can't find them.  I looked on the CMS/Novitas website but nothing seems to be what I need??  I even called Novitas for help and they had me write a question into Novitas which they have never answered.It seems as though they could not find them either.  (It makes me feel stupid that I can't navigate the CMS site.)  Should I look somewhere else??  Thanks for your reply to my question.  Tobie


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## RFoster1 (Jul 24, 2013)

tobieforte said:


> I can't find them.  I looked on the CMS/Novitas website but nothing seems to be what I need??  I even called Novitas for help and they had me write a question into Novitas which they have never answered.It seems as though they could not find them either.  (It makes me feel stupid that I can't navigate the CMS site.)  Should I look somewhere else??  Thanks for your reply to my question.  Tobie



http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html


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## kbartrom (Jul 24, 2013)

Per NCCI the two codes are bundled. However, a modifier is allowed.  If documentation supports a separate identifiable EM service (which it likely does on an initial hospital visit), I would consider appealing the denial.


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## tobieforte (Jul 25, 2013)

Thank you for your reply.


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