Wiki 36478 with 36471 new NCCI edit

[healing13]

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?

 

[htidd]

I'm having the same issue, I code for a vein clinic and the new edit just hit for us as well. I"m trying to figure it out too. The doctor is treating different varicose veins with two treatments so I'm leaning towards using modifier 59 on the sclerotherapy. The doctor is arguing with me that there shouldn't be edits between these two codes which of course I have no control over what CMS does.

 

[marandee]

Modifier is needed to (XS different structure) if accepted.

 

[Priscilla Keogh]

The edit has an indicator of “1” which allows for billing with a modifier such as 59 or XS in order to bypass the edit when appropriate. An example for billing separately would be if the two procedures are performed at separate anatomic sites or at separate patient encounters on the same date of service.