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Last Modified: 11/17/2011
Location: FL, PR, USVI
Business: Part B
CO 236
This procedure or procedure/modifier combination is not compatible with another procedure /modifier combination provided on the same day according to the National Correct Coding Initiative.
(DENIED/REDUCED SERVICE/PROCEDURE NOT PAID SEPARATELY)
(PRE/POST OP CARE INCLUDED IN SURGERY. YOU MAY NOT BILL PATIENT)
(SEPARATE PAYMENT NOT MADE FOR THIS SERVICE. DO NOT BILL PATIENT)
Resources/tips for avoiding this denial
Denial indicates service(s) billed has/have already been paid as part of another service billed for the same date of service (services were bundled).
• The purpose of NCCI edits is to ensure the most comprehensive codes, rather than component codes, are billed.
If billing for split-care, be sure to apply appropriate modifiers to surgical codes when billing the services to Medicare. Note: Coordinate split-care billing activities with other providers involved in the patient's care, to ensure the surgical code is billed before post-op care, as this will sometimes cause denial issues.
• Modifier 54 indicates pre- and intra-operative services performed.
• Modifier 55 indicates post-operative management services only.
• Modifier 56 indicates pre-op services only
Some services may always be bundled into other services provided or not separately payable. For instance:
• Evaluation and management (E/M) services conducted during the post-op period of a surgery that are related to the surgery are considered not separately payable.
• See the Centers for Medicare & Medicaid Services (CMS) Internet-only manual (IOM), publication 100-04, chapter 12, section 30.6.6 
for additional details.
for additional details.• Collection of a blood specimen is usually conducted during a patient encounter, and therefore is not separately payable.
• Extended hours codes (common after-hour codes) are not separately payable in a facility which operates 24-hours a day (e.g., inpatient/outpatient hospital).
• Special handling, conveyance or transfer of a specimen to a laboratory from a physician's office is not usually separately payable, as this type of "extra" care is considered within the payment fee schedules.
• For an introduction to NCCI, access the recording of a FCSO webcast dated October 7, 2010 -- 10/07 -- National Correct Coding Initiative (NCCI) and related denials Part B, located under category "2010 FCSO Medicare Training webcasts" of the FCSO University 
, under "Learning and Metrics."
, under "Learning and Metrics."• To understand how billing for services or procedures performed in the global period of a surgery can be affected, complete the free Web-based training (WBT) Introduction to Global Surgery -- Part B
• Click here for instructions on registering for a FCSO University training account.
Tips to correct the denied claim
If a modifier is applicable to the claim, apply the appropriate modifier and resubmit the claim. Be sure to submit only the corrected line. Resubmitting an entire claim will cause a duplicate claim denial.
• Refer to the Modifier FAQs for additional information.
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
