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Injection Administration: 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
- CPT code: 90772
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).
Resources
- Check CCI edits prior to claim submission; edits are updated quarterly. CCI edits are available at www.cms.hhs.gov/NationalCorrectCodInitEd/
- As of 7/31/07, CPT code 90772 is bundled with many CPT codes, including E/M CPT codes 99201-99456. If 90772 is a separate, distinct service and is marked with indicator '1' in the CCI edit list, submit CPT modifier 59. Examples of separate, distinct services include situations in which the injection was administered at a different patient encounter. Supporting documentation is required in the medical records.
- For additional, 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: