CCI edits - Standards of Medical Practices

[RebeccaMoney]

My office is having a discussion on what exactly this means. Encoder Pro will show that two codes are bundled with the reason as "Standards of medical practice" and a modifier is allowed. My understanding is that a modifier is only allowed if a separate incision or contralateral side . Am I correct?
thanks,

 

[kellz0913]

This is from the 2019 NCCI Manual about that. "Standards of medical/surgical practice: Under Medicare, all services necessary to complete a procedure based upon standard medical/surgical practice are included in the procedure. Many procedures that are typically necessary to complete a more comprehensive procedure have been assigned independent HCPCS/CPT codes because they may be performed independently in other settings. The service described by HCPCS/CPT code ____ (the column two HCPCS/CPT code) is typically included when performing the procedure described by HCPCS/CPT code ____ (the column one HCPCS/CPT code) and is therefore bundled into HCPCS/CPT code _____(the column one HCPCS/CPT code.)"

 

[RebeccaMoney]

Thank you,