Wiki EM code denied

[Ritukap11]

our bill review company denied EM code 99282- reason per state guidelines EM codes are disallowed when billed with packaged /non starred surgery codes they billed for 16020 the provider billed for a visit on the same day of surgery or within the same followup period of a performed surgery - is this true- 2021

 

[lgardner]

I don't know much about burn procedures, but there are no CCI edits between the 2 codes.

AND, in the CPT book right before the 060** codes, it states :
"For necessary related medical services (eg. hospital visits, detention) in management of burned patients, see appropriate services in Evaluation and Management and Medicine sections."

To me, this sounds like the 16020 can be billed with an E/M.

I hope an expert comes along and confirms this.

 

[thomas7331]

The fact that they're making a reference here to 'state guidelines' suggests to me that this is perhaps a local requirement, perhaps specific to a state program such as your state's Medicaid or Workman's Compensation. Also, the term "non-starred surgery codes" is not widely used in coding, so that also tells me this is something payer-specific. If so, it's likely part of their reimbursement methodology by which they calculate payments using a surgical code or an E/M code but not both. I think you'd need to contact the payer (or your bill review company) to get more information about this.

 

[Ritukap11]

I don't know much about burn procedures, but there are no CCI edits between the 2 codes.

AND, in the CPT book right before the 060** codes, it states :
"For necessary related medical services (eg. hospital visits, detention) in management of burned patients, see appropriate services in Evaluation and Management and Medicine sections."

To me, this sounds like the 16020 can be billed with an E/M.

I hope an expert comes along and confirms this.

Thank You !

 

[Ritukap11]

The fact that they're making a reference here to 'state guidelines' suggests to me that this is perhaps a local requirement, perhaps specific to a state program such as your state's Medicaid or Workman's Compensation. Also, the term "non-starred surgery codes" is not widely used in coding, so that also tells me this is something payer-specific. If so, it's likely part of their reimbursement methodology by which they calculate payments using a surgical code or an E/M code but not both. I think you'd need to contact the payer (or your bill review company) to get more information about this.

Thank You!