NCCI Bundling Denials Code : M80, CO-B15

Creatinine (Blood): NCCI Bundling Denials Code : M80, CO-B15


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: 82565

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; edits are updated quarterly. NCCI edits are available at www.cms.gov/NationalCorrectCodInitEd/.

• Use the Palmetto GBA NCCI tool to determine if the service you are submitting is bundled with another service

• CPT code 82565 is bundled with CPT code 80047. CPT code 82565 is also bundled with the following CPT codes: 80048, 80053, 80069 and 82575.

o For these combinations of services, CPT code 82565 is designated with indicator '1' in the CCI edit list. If this is a separate, distinct service, submit CPT modifier 59 to denote it as a separate service.

Examples of separate, distinct services include tests that are performed different patient encounters. 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:

o Jurisdiction 1: Select 'Articles' on the left side of the Palmetto GBA Web page

o Ohio, South Carolina and West Virginia: Select 'Browse by Topic' on the left side of the Palmetto GBA Web page


 Common Reasons for Message

    Combination of codes billed on same date of service by same provider may not be appropriately paired together due to National Correct Coding Initiative (NCCI) Edits
        Payment for service billed is bundled into payment for another service performed that day
        It is unusual for services billed to be performed together
    Modifier used to unbundle is on incorrect code or incorrect modifier was used

Next Step

    Verify code set is appropriate to be billed together
    Submit Appeal request to add modifier, if appropriate
        See Appeals webpage for instructions on how to submit a Reopening or Redetermination

Claim Submission Tips

    Review NCCI Coding Edits External Link prior to submitting claim to determine if codes are appropriately paired

        View How to Use Medicare NCCI Tools External Link

    When appropriate, modifier to identify separately identifiable service should be appended to Column 2 code
        Modifier Indicator "0" – there are no circumstances in which both procedures of a code pair should be paid; modifier is not allowed for NCCI purposes
        Modifier Indicator "1" – modifiers associated with NCCI are allowed with this code pair when appropriate
        Modifier Indicator "9" – NCCI edit does not apply to this code pair; edit for code pair was deleted retroactively

    Providers may not bill patient for NCCI edit denials
        Denial is based on incorrect coding
        Providers should not complete an ABN for NCCI edits

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