Ob-Gyn Coding Alert

Because the Correct Coding Initiative (CCI) version 9.0 adds a significant number of mutually exclusive codes to its edits, understanding what this designation means and how it affects coding and reimbursement is critical to your ob-gyn practice.

Mutually exclusive codes represent procedures that a physician cannot reasonably perform during the same session, according to CCI. For example, when an organ can be repaired by two different methods, the doctor must choose one and report it. Similarly, you cannot code for an initial service and a subsequent service at the same time.

CCI identifies mutually exclusive code pairs based on either the CPT definition or the medical impossibility or improbability that the procedures could be performed at the same session. These code pairs should not be reported together, CCI states.

CCI presents these mutually exclusive codes in a separate table. The codes are listed in column 1 and column 2, but this does not mean that the column-1 code includes the services represented by the column-2 code. Instead, it merely means that the two codes cannot be reported at the same time.

When Medicare carriers process claims containing mutually exclusive codes, they will generally reimburse only the code with the lower work relative value units (RVUs), CCI says. Consequently, CCI has placed the code with the lower RVUs in column 1.

In addition, CCI includes either a "0" or a "1" indicator next to each code pair. If the pair has a "0" indicator, you cannot bypass the edit with a modifier (such as modifier -59, Distinct procedural service), and you will be paid only for the lower-valued code. But if the code pair has a "1" indicator, you can bypass the edit, but Medicare will pay the column-1 code (the lower-valued code) at the full allowable and the column-2 code at a reduced rate.