Internal Medicine Coding Alert

Question: How should we report 99233 and 49080 to Medicare on the same day? I don't believe the NCCI edits bundle the codes.

South Carolina Subscriber

Answer: Even though the National Correct Coding Initiative (NCCI) doesn't bundle these codes, the physician fee schedule gives 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) no global days. This means that if the physician performs any E/M service, such as 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...), on the same day as the peritoneocentesis, the payer will likely consider the E/M part of the procedure.

The exception is if you report the E/M as a separately identifiable service. In that case, you could attach modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99233, as long as your documentation supports the charge.