Wiki Seperate payment for E/M with procedure same day

[MMadrigal]

Effective 7/1/13, we stopped getting reimbursed for E/M with modifier -57 or -25, when
billed the same day as a procedure, either injections, closed reductions, etc. I was told by the insurance carrier this is due to CCI 19.2 edits.

Does anyone have a link where I can read the changes? Thank you in advance. Mary

 

[cynthiabrown]

we are receiving denials on mod 57 from our mediare carrier NGS as well. Let me know if you find out anything

 

[cynthiabrown]

I have determined that mod 57 ,25,24 were not bypassing edit in july-oct, starting October 1, it has been fixed

 

[dclark7]

There was an error in the NCCI edits published 7/1. This has been corrected with the 10/1 update and most MACS are reopening the claims, but you have to call to get them reopened they're not going back to reprocess.

 

[MMadrigal]

CCI Edit correction

There was an error in the NCCI edits published 7/1. This has been corrected with the 10/1 update and most MACS are reopening the claims, but you have to call to get them reopened they're not going back to reprocess.

This is great news. Do you have a link to the correction of the Edit? I would like to include something in writing from Medicare/Medicaid when we appeal all our denied claims. Thanks so much, Mary

 

[KMCFADYEN]

We had quite a few of these denied claims. We were holding them until the edit was corrected. Oddly enough, all but 2 were recently paid. We did not appeal or resubmit the paid ones. But the 2 we did something with are still "pending"-possibly being ruled out as duplicates?