I am trying to determine why an CCI edit would initiate based on the following two examples.
1. Place of Service is a 22 (outpatient hospital). Procedures 27446 and 29877 were performed during the encounter. According to the CCI edit POS 22 is invalid for procedure 27446. I did further research and found that code 29877 is a component of 27446, but nothing related to the place of service.
2. Place of Service is an ASC POS 24. Procedures 45378 and 43239 were performed. According to the CCI edit 43239 is disallowed with 45378. I did some research and found that if one procedure is more extensive than the second, the payment to the provider is based off of the first procedure. However, when I place these two codes into an encoder, both are allowed separate payment with the exception of 43239 taking a 50% cutback.
Could anyone shed light on the CCI edits for place of service and secondary procedure disallow?
I would appreciate the help.
1. Place of Service is a 22 (outpatient hospital). Procedures 27446 and 29877 were performed during the encounter. According to the CCI edit POS 22 is invalid for procedure 27446. I did further research and found that code 29877 is a component of 27446, but nothing related to the place of service.
2. Place of Service is an ASC POS 24. Procedures 45378 and 43239 were performed. According to the CCI edit 43239 is disallowed with 45378. I did some research and found that if one procedure is more extensive than the second, the payment to the provider is based off of the first procedure. However, when I place these two codes into an encoder, both are allowed separate payment with the exception of 43239 taking a 50% cutback.
Could anyone shed light on the CCI edits for place of service and secondary procedure disallow?
I would appreciate the help.