tci E/M Coding Alert - 2019 Issue Q3

Reader Question: Question Payer Policy in This E/M Bundle

Question: A carrier is denying a claim for a 99213 with an 81000 saying that the urinalysis is bundled into the E/M service. What is the best way to unbundle the service? West Virginia Subscriber Answer: No National Correct Coding Initiative (NCCI, or CCI) edit exists for 81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy) when it is paired with 99213 (Office or other outpatient visit for the evaluation and management of an established patient …). The denial...

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