tci ED Coding & Reimbursement Alert - 2015 Issue 8

Reader Questions: My Payments For 31500 Are Going Down The Tube!

Question: I billed 99285-25 with 31500, but insurance has denied the claim saying 31500 is not a covered charge. This does not sound correct. Can you help? Delaware Subscriber Answer: You are correct that 31500 (Intubation, endotracheal, emergency procedure) should not be bundled into a 99285 (Emergency department visit for the evaluation and management of a patient…). They are very clearly separate services. The CCI edits for this code pair do not include ED E/M codes (99281-99285) or critical care (99291), although the time spent performing the procedure would have to be backed out of the critical care...

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