Question AAOS and AAPC vs CCI edits

primrose1

Guru
Messages
118
Best answers
0
I'm newly employed to an organization that codes strictly to Medicare guidelines/CCI edits regardless of patient insurance coverage (except for work comp and no fault). I've always used information from the Coding Companion books to appeal claims that are denied for modifier 59 usage (i.e. 29881 & 29875 (the plica/synovectomy was done in a different compartment). However, the new employer is telling me under no circumstances am I to code these two together because I would be unbundling these codes and I would be wrong. I tried to explain that I've been able to appeal past denied claims with submitting the operative note and the Coding Companion information and successfully received payment but I was told to cease this practice due to the CCI edits. I feel like we'd be leaving money on the table. Am I wrong in feeling this way? There were other procedures with similar modifier 59 usages, but again, I was told because of their strict CCI edit following, I need to change in how I code going forward and forget about the info from the AAOS and essentially the AAPC Coder Lite subscription that I have and use daily. Any thoughts/advice would be appreciated.

Thank you.
 

Orthocoderpgu

True Blue
Local Chapter Officer
Messages
950
Location
Salt Lake City, UT
Best answers
1
I'm newly employed to an organization that codes strictly to Medicare guidelines/CCI edits regardless of patient insurance coverage (except for work comp and no fault). I've always used information from the Coding Companion books to appeal claims that are denied for modifier 59 usage (i.e. 29881 & 29875 (the plica/synovectomy was done in a different compartment). However, the new employer is telling me under no circumstances am I to code these two together because I would be unbundling these codes and I would be wrong. I tried to explain that I've been able to appeal past denied claims with submitting the operative note and the Coding Companion information and successfully received payment but I was told to cease this practice due to the CCI edits. I feel like we'd be leaving money on the table. Am I wrong in feeling this way? There were other procedures with similar modifier 59 usages, but again, I was told because of their strict CCI edit following, I need to change in how I code going forward and forget about the info from the AAOS and essentially the AAPC Coder Lite subscription that I have and use daily. Any thoughts/advice would be appreciated.

Thank you.
I would follow what your employer is asking you to do. I would take the opportunity to educate them when you can without being pushy. Not all insurance companies follow the CMS/NCCI edits. And yes, you will lose a bit of money due to strictly following CMS. Your employer may be concerned with audits, which is great because many are not and want coders to bill inappropriately.
 
Top