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Heparin: CCI Bundling Denials
Denial Reason, Reason/Remark Code(s)
- M-80: Not covered when performed during the same session/date as a previously processed service for the patient
- CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
- HCPCS code: J1642
Correct Coding Initiative: The Correct Coding Initiative (CCI) packages, or 'bundles', reimbursement for some services under Medicare. CCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).
Resolution/Resources
- Check CCI edits prior to claim submission; edits are updated quarterly. CCI edits are available at www.cms.hhs.gov/NationalCorrectCodInitEd/.
- HCPCS code J1642 is bundled with a number of CPT codes, including some imaging studies in the 78xxx series and some echocardiography procedures. For codes that are bundled with HCPCS code J1642 with indicator '1,' claims for HCPCS code J1642 may be reimbursed separately if the services are separate and distinct, such as if the heparin was administered for a different procedure than the procedure bundled with the injection or if the heparin was administered at a different patient encounter. Submit CPT modifier 59 in these instances. Supporting documentation is required in the patient's medical record.
- For specific information on modifiers that may be used to denote exceptions to CCI (including CPT modifier 59), refer to the Palmetto GBA Modifier Lookup tool: