Wiki 92504

[Thearslee]

Is there any NCD edits for the 92504, I know It can not be billed with another procedure in that area, but if the provider does an E/M and JUST the 92504 why won't the insurance cover??

 

[b.cobuzzi]

When you look at the fee schedule for 92504 (in CODIFY) you see that the global for 92504 is xxx. NCCI in version 7.2 said that a payer can treat xxx global day procedures like minor procedures, 0 or 10 global days. So, all I can think is that your payer is doing that, therefore requiring a 25 modifier on the EM when using the xxx global day 92504.