NCCI 101:
Navigate the Edits Lingo
Published on Fri Aug 01, 2003
Tired of bungling bundles and misinterpreting mutually exclusives? Brush up on your National Correct Coding Initiative (NCCI) terminology and avoid mistakes that could otherwise put you in the NCCI doghouse.
Mutually exclusive codes. According to NCCI, mutually exclusive codes are those that should not be billed together due to conflicting CPT definitions or "the medical impossibility/improbability that the procedures could be performed at the same session." Although these codes technically are not bundled, they should not typically be reported on a single claim. When you report codes identified as mutually exclusive for a single surgical session, usually the carrier will recognize and reimburse only the lesser-valued procedure.
For example, if a urologist performs a ureterocolon conduit (50815, Ureterocolon conduit, including intestine anastomosis) he would not also perform a ureteroileal conduit (50820, Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker operation]) at the same surgical session.
In another example, if a urologist performs a subsequent male urethral dilation (53601*, Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent), he could not possibly perform and bill for an initial male urethral dilation (53600*, Dilation of urethral stricture by passage of sound or urethral dilator, male; initial) at the same surgical session.
Bundled codes. A bundle is the commonly used term to describe a pair of codes, one of which represents the comprehensive code and the other represents the component code. NCCI considers the service represented by the component code included in and not separately billable from the service represented by the comprehensive code. NCCI outlines the rationale for bundling component codes into comprehensive codes:
The included (or bundled) service represents the standard of care in performing the overall service (the comprehensive code)
The included service is necessary to successfully accomplish the comprehensive procedure; failure to perform the component procedure may compromise the success of the procedure
The component code does not represent a separately identifiable procedure unrelated to the service represented by the comprehensive code.
For example, an antegrade percutaneous endopyelotomy (50575, Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy [includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent]) is considered comprehensive of (and includes) the following services: 50395 (Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous), 50570 (Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) and 50393 (Introduction of ureteral catheter or stent into ureter [...]
