Primary Care Coding Alert

Question: How can I find out whether Medicare bundles two services, such as an established patient office visit and health and behavior assessment?

North Carolina Subscriber

Answer: You can search the National Correct Coding Initiative (NCCI) edits to determine whether Medicare will consider a code pair "bundled." The annual CD-ROM file contains all current bundles and permits code pair searches. CMS issues quarterly Excel updates and compiles changes in the subsequent year's master file.

If you enter 96150 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, healthoriented questionnaires], each 15 minutes face-to-face with the patient; initial assessment) into the NCCI's latest annual CD-ROM (version 10.0), the system lists the code as a component of E/M services, such as 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient ...). This means that Medicare and other payers that follow NCCI will bundle initial health and behavior assessment into an office visit. Medicare bases this edit on CPT, which states that you shouldn't report E/M service codes with health and behavior assessment codes  on the same day.

You must subscribe with National Technical Information Service (NTIS) to receive the annual searchable CD-ROM. But you can check out the quarterly NCCI edit updates for free at www.cms.hhs.gov/physicians/cciedits.