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
- B15 - Bundling: 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 codes: 96372, 96374
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/.
- As of January 1, 2009, CPT codes 96372 and 96374 are bundled with many other procedures, including electroconvulsive therapy, biofeedback, some CPT codes for dialysis management, esophageal studies, some ophthalmologic studies, some diagnostic pulmonary procedures including spirometry, and many cardiovascular procedures including electrophysiologic studies, cardiac stress tests, and echography and diagnostic cardiology studies. Note that this is not an inclusive list.
- Also, as of January 1, 2009, many Evaluation & Management (E/M) procedures are bundled into (included in the reimbursement for) CPT codes 96372 and 96374
- For these combinations of services, CPT codes 96372 and 96374 are designated with indicator '1' in the CCI edit list. If this is a separate, distinct service (e.g., performed during a separate patient encounter), submit CPT modifier 59 to indicate that the injection procedure is a separate service. Documentation in the patient’s medical record must support the use of this modifier.
Reference