Wiki Mckesson Edits


mawhah, NJ
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does anyone know that rules for the McKesson Edits? and/or how they are different than the CCI edits? Specifically, I work for a radiologist company and we only do the reading for a hospital and codes 76856 76830-59 have been getting rejected. They were always paid up until recently and don't know why. Any info would be much appreciated.

thank you!
McKessons tends to heavily favor payer ideas of "bundling". Most of its edits are loosely based on CCI, then expanded. As for the logic, sometimes I do not believe there is any to what McKesson insists is an "edit."

Whoever works for this company takes their liberties at doing some heavy personal interpretation and invention on bundling rules--unless things have changed drastically in the past few years.

This doesn't help any, but might help to explain your (and my) confusion. The payers trust these edits way too much, in my opinion.
From the looks of it I am not sure that this one is a McKesson edit, the problem may be that you are using a 59 when it is not required. I have worked radiology for many years and have never had to add a 59 -- at most we have to use a 51 for some payers.