Wiki 0 day global procedure with E/M

[kimmcelderry@gmail.com]

Hi there, I've written off several e/m visits due to them being bundled with 64455 by BCBS. I want to know if I should be appealing these denials instead.
We are billing
99213-25 (verified separate e/m)
64455
xray
Jcode

BCBS states that even with the 25 mod, the 99213 is bundled with the 64455. This doesn't seem right to me. Any thoughts?

 

[thomas7331]

I would start by taking a look at your local BCBS plan's policies regarding this, and also at your practice's contract, if you have one. If the policies says that they will not pay these under any circumstances and your contract states that your practice has agreed to abide by the policies, then there would be no point in appealing. But if the policies allow for reimbursement in certain circumstances and your provider's documentation meets those requirements, then by all means you should be appealing to show that those services are eligible for payment.

 

[kimmcelderry@gmail.com]

I asked them to provide me with their policy on this and they said they didn't have it. I will probably appeal since they couldn't provide me with this information and there are no CCI edits on billing these codes together. Thanks!