Wiki 36478 with 36471 new NCCI edit?

healing13

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A new NCCI edit was published 10/01/19 against codes 36478 with 36471 stating "Misuse of column two code with column one code". Does anyone have any idea what exactly constitutes misuse? We have provider who do perform these services in the same session and I want to be sure they are not billing against this edit. For instance- is misuse defined as performed in the same surgical field? Same vein? Same leg? Other? Does anyone have insight on this edit?
 
I see this is an old thread and no replies but I am addressing this with UHC today. The 36478 and 36471 are different sites, different incisions and different equipment which definitely justifies a 59 modifier. UHC pays this with 59 on commercial claims but does not on Medicare claims because of this edit. Medicare pays it without issue. Not only pays it but we have gone thru RAC audit of over 20 charts and they all passed. So today UHC is meeting with me to 'educate me on how to code' as they think they are the ultimate authority. If they continue to deny I will report them to CMS. It is ridiculous to have to appeal many of these. Funny that for the exact same procedures they pay about half and deny the others!!!
 
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