Wiki CCI Edits

[Vrdurden]

For some reason, CCI edits have always been challenging for me.
I have 2 procedures performed during surgery. When I check CCI edits one way, 14060 as first and 67966 as second there is no edit. But when I flip 2 codes, and search 67966 as first and 14060 as second procedure, they are bundled. Can someone explain to me why that is? Both are "major" procedures (90 global) and 14060 pays slightly more. Can I bill 14060 as primary procedure and 67966 as secondary and not get denied?
I would greatly appreciate your help. It's just not clicking for me.


Vicki Durden
Lake Eye Associates

 

[Orthocoderpgu]

Using EncoderPro 67966 has a higher RVU of 21.96. Code 14060 21.90. Shows that 67966 is the primary between the two. Since they do hit an edit, in order to bill out both they would have to "qualify" for a -59 modifier. If they don't qualify, they bundle.

 

[Vrdurden]

Using EncoderPro 67966 has a higher RVU of 21.96. Code 14060 21.90. Shows that 67966 is the primary between the two. Since they do hit an edit, in order to bill out both they would have to "qualify" for a -59 modifier. If they don't qualify, they bundle.

Sorry I should have specified they were being done in facility. Therefore 14060 RVU 19.00 is higher than 67966 RVU 18.57. That being said wouldn't that make 14060 the primary procedure and does that change anything as far as billing them together?

 

[Orthocoderpgu]

I don't do facility billing, surgeons only. So I'm not sure. Hopefully someone out there will be able to help out.

 

[such78]

Excision, lesion of lower lid and adjacent tissue transfer

CPT Assistant, November 2012 Page: 13 Category:
Related Information

Surgery: Integumentary System

Question:

Is it appropriate to report CPT code 14060 in addition to code 67966 when an eye lesion is excised from the lower lid and an adjacent tissue transfer is then performed?

Answer:

No. The guidelines for the adjacent tissue transfer or rearrangement codes 14000-14302 state that these codes include the excision (including lesion) and/or repair byadjacent tissue transfer or rearrangement. The excision of the lesion (code 67966, Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin) in this case is included in the work described by codes 14000-14302. Therefore, it would not be appropriate to additionally report code 67966.