Wiki Add on code 38747 Bundling Issue

[kgillin]

Beginning in 2010 CCI version 16.0 began bundling add on code 38747 with certain procedures such as 44150, etc. No one in our office has seen where we have had to use -59 modifier on an add on code before. We thought maybe it was one of the many mistakes in this first version. But when the CCI version 16.1 came out for the second quarter it still shows being bundled. We have researched this and keep coming up short of a clear answer. One time the claim is paid and the next it is denied. Has anyone else come across this issue and may have an explanation as to why this is now bundled?

 

[cmartin]

Hi Katrina,
I posted on this same issue on 5/26 and no one has answered mine, either! I did "search" using 38747 b/4 I posted but I didn't get any results - then today when I was trying to find my post to see if there were any answers, it turned up both mine and yours! I originally planned to go to the ntl. conference this year and was going to try to get some info there, but when they had to change the site I couldn't go after all, so tried posting. No luck after this long tells me we aren't missing anything - there really ISN'T a rational explanation for this! What a pain - I've gotten them to change the NCCI b/4, but it takes a long time and this seems so obviously erroneous!
Connie
CPC,CGSC

 

[mkknowle]

mkgolliet

Hello,

I just found this thread when researching the same issue. According to 2018 NCCI guidelines, Chapter 5.E.2: CPT code 38747 (abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and venal caval nodes...) shall not be reported for the excision of lymph nodes that are in the operative field of another surgical procedure. For example CPT code 38747 shall not be reported for the excision of lymph nodes in the operative field of a gastrectomy, pancreatectomy, hepatectomy, colectomy, enterectomy, or nephrectomy.

This verbiage is in the 2010 manual as well. So it seems that CPT says the code combination can be be billed together but NCCI says it cannot.

Marisa Golliet, CPC, CPEDC