ncci edits

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    Wiki CMS Rescinds UDT NCCI Edits

    Good news for my fellow lab billers! CMS has decided to retroactively rescind/delete the urine drug testing NCCI edits back to 7/1/23. I'm not sure what they hoped to accomplish with the edit, but apparently it wasn't the solution they hoped for. If they were looking for ways to put further...
  2. L

    Wiki Best Noridian NCCI Reference available Online?

    I suspect based on my denials that the source I'm using isn't correct. Is there a reliable online source to compare codes against Noridian specific NCCI edits? Thanks!
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    Wiki I need NCCI quarterly edits for 4th quarter 2019

    Does anyone know where I can find these or have an archived copy you could send me? Thanks!!! Eve
  4. N

    Wiki Unrelated E/M with procedure

    Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new...
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    Wiki Dacryocystorhinostomy

    Anyone know if 31239 Dacryocystorhinostomy and 68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent can be coded together? I don't see any NCCI edits but wasn't sure if insurance would still consider this bundled.
  6. S

    Wiki Behavioral Health Billing and NCCI Edits

    Does anyone in Ohio have experience with billing an E/M on the same date of service as Individual Psychotherapy Treatment but under the same tax identification number but two different provider NPI numbers? Example: 99214 by the M.D. 90834 by the LPC They are billed under...
  7. A

    Wiki 30520 and 30930

    I have read that some say you can bill 30520 (septoplasty) and 30930 ( fracture nasal inferior turbinates) together and some say it is bundled. There is no NCCI edits so does anyone know if you can bill these codes together or if payers bundle these two codes?
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    Wiki Coding 42415 and 14040 together?

    Can cpt codes 42415 (excision of parotid tumor with dissection and preservation of facial nerve) and 14040 (advancement flaps) be coded together? I don't see NCCI edits for these codes but I wanted to check if 42415 does include the advancement flaps.
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    Wiki Midline thyroid isthmusectomy

    The doctor said he did a tracheal fenestration with skin flaps and midline thyroid isthmusectomy. I know the cpt code for the tracheal fenestration is 31610 and based on the details I believe the cpt code for the isthmusectomy would be 60200 since the details say transected but I want to make...
  10. J

    Wiki Separately identifiable E/M

    There seems to be a lot of ambiguity in defining separately identifiable E/M services. We have scenarios where patients were referred to different specialtists (Cardiology, ENT, GI, etc) who come and evaluate the patient. They eventually decide that the pt will have to undergo a procedure (Heart...
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    Wiki PT, OT and ST modifier HELP

    Can someone please assist me? NCCI edits state CPT code 97110 is a component of CPT code 92507. Would the modifiers GP (on 97110) and GN (on 92507) be sufficient to identify the two modalities as distinct and separate? Or would you need a XP, XS, XE, XU, 59?
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    Wiki NCCI Edit help requested

    Greetings! Looking for everyone's best advice on NCCI edits! I have been certified a couple years now and have basic understanding of NCCI edits - but would like to do a deeper dive and wonder if anyone has great advice, best resource(s), etc. to recommend. How did you get to the best...
  13. M

    Wiki Complex repair 13132 rejected after billed with 17000 destruction

    I'm new to Derm. Patient had Mohs layer 17311 and the following on the same DOS. Patient had complex repair 13132, and the physician also destroyed a lesion- 17000. The Mohs and destruction paid; however, the complex repair was denied- (PTP edits for 13132 to the 17000). Is this a simple fix...
  14. C

    Wiki Separate professional/technical charges for lab codes 80047 an 80048

    Providers are billing separate charges for technical (hospital) component and professional (lab) component of codes 80047 and 80048. Per NCCI, these codes do not have a separate technical/professional component therefore the hospital is billing the total component (no modifier applied) and...
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    Wiki PTP Edits 2017!!

    Hello! So I have ran into a little bit of a problem. In my office we use Encoder and I use the NCCI edits checker all the time. However, when a CPT code get deleted Encoder no longer recognizes it and I can't look up NCCI edits for past dates of services. (I work on the follow up team. I work...
  16. R

    Wiki Question regarding Debridement coding and NCCI Edits

    Hello, I am a coder at a small billing company and one of our clients specializes in debridement procedures. According to a recent update in NCCI Edits, the codes 97597 and 97598 can't be coded together. We think this is the result of a very recent change in CPT and there is a different code...