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NCCI edits and secondary Medicare


Best answers
Good morning!
When a patient has Medicare as their secondary insurance payor, and the primary is Humana or Aetna or some other commercial entity payor, does NCCI bundling edits apply to the primary insurance??
For example, I work in Pathology, and a common NCCI edit is 88112 and 88104. These are bundled together and cannot be billed together on Medicare patients. But what if:confused: the primary payor is a Non-Medicare entity?? We know Medicare will deny it as secondary, but can we bill both codes to the primary payor anyway, just as we would if they did not have Medicare as secondary??

Please help!! We are in great debate about this in our office!

Stephanie Duvall, CPC


True Blue
Best answers
The NCCI edits should be used globally regardless of the payor. If the NCCI edits state they are bundled then I would not "unbundle" just because its not Medicare unless you have something in writing from the payor stating its okay to unbundle (which is highly unlikely).

Just my two cents :)