EKG, EKG Rhythm Strip and Cardiac Echography: NCCI 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: 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: 93010, 93042 and 93320

National Correct Coding Initiative
The National Correct Coding Initiative (NCCI) packages or 'bundles' reimbursement for some services under Medicare. NCCI 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 NCCI edits prior to claim submission on the CMS website; edits are updated quarterly
• Use the Palmetto GBA NCCI tool to determine if the service you are submitting is bundled with another service
• CPT codes 93010 and 93042 are bundled with many CPT codes including Percutaneous Transluminal Coronary Angioplasty (PTCA), many diagnostic procedures and some other EKG codes
• CPT code 93320 is bundled with various codes including CPT codes 93306, 93307, and 93308.
• If these services are separate, distinct services and are marked with indicator '1' in the NCCI edit list, submit CPT modifier 59. Examples of separate, distinct services include situations in which the rhythm strip was taken 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 NCCI (including CPT modifier 59), refer to the Palmetto GBA Modifier Lookup tool located under Self Service Tools on our home page