Neurosurgery Coding Alert

Question: Would you explain what the differences are between mutually exclusive and "column 1/column 2" edits that come from the Correct Coding Initiative (CCI)? Florida Subscriber Answer: Mutually exclusive edits pair procedures that are services that the physician could not reasonably perform at the same session on the same beneficiary. For example, CCI lists 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) as mutually exclusive of 61313 (... intracerebral). The payer would not expect that the neurosurgeon would perform both types of craniectomy on the same date for the same patient because they describe different, exclusive procedures. Bottom line: If you were to report two mutually exclusive codes for the same patient during the same session, Medicare would reimburse only for the lesservalued of the two procedures (in the case of 61312 and 61313, the payer would reimburse only 61312). Column 1/column 2 edits describe "bundled" [...]