NCCI Edits for mutally exclusive procedures

[aliciaripa]

When CPT code is in column 1 e.g. 17000 and in column 2 is 17261 and it shows a 1 for modifier but beside it says PTP edit rationale says mutually exclusive procedures, does this mean you can never charge the two together even with a modifier? Insurance is saying it just falls under mutually exclusive therefore you can't charge the two together even with a modifier. Is that true?

 

[CodingKing]

0 means no modifier will bypass. 1 means if it meets criteria for separate reporting that a modifier will bypass the edit.

In this case if one lesion is a premalignant lesion and the other lesion was a malignant lesion you can add a modifier to the 17000.

 

[IpshitaB]

Billing of mutually exclusive codes

Hi,

I too have similar doubt as above scenario. So to bill 17000 and 17261 we need to check malignant and pre-malignant condition.
Can you please explain me billing of CPT codes 25111 and 25112, and CPT's 85008 and 85007. Both are examples of Mutually exclusive edits, the first with Modifier (Allowed) and the second without Modifier (Not allowed).

 

[AuditingAutumn]

which column?

Hello,

If it's a "1 means if it meets criteria for separate reporting that a modifier will bypass the edit." listed, which column would the modifier apply to? Column 1 or 2?

Example: Would the modifier 59 go on the 90853 or 90834?
Column 1 Column 2 *=in existence Effective Deletion Modifier

90853 90834 20141001 * 1

Thank you for your time!

 

[CodingKing]

Hello,

If it's a "1 means if it meets criteria for separate reporting that a modifier will bypass the edit." listed, which column would the modifier apply to? Column 1 or 2?

Example: Would the modifier 59 go on the 90853 or 90834?
Column 1 Column 2 *=in existence Effective Deletion Modifier

90853 90834 20141001 * 1

Thank you for your time!

If it meets criteria it goes on the column 2 code.