Wiki NCCI edits vs Mutually exclusive edits

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uhlerclarem

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Our Medicare carrier-Palmetto- has two files listed- one as CCI edits (column 1 vs column 2 edits) as well as a file listed as Mutually Exclusive edits. The codes seem to be the same, but in different order-is there any difference between these edit lists?
Thanks
 
CCI edits consist of 2 types of edits the first being the one you are most familiar with,
Component of comprehensive
2 or more procedures where 1 or more of the listed procedures is consider to be a component of the more comprehensive procedure.
the other type of edit you may not be as familira with
Mutually exclusive
2 procedures that are considered to be impossible or improbably to be performed on the same patient on the same day. Some combinations are modifiable and some are not. Just be sure to use the correct modifier.
I hope this is of assistance for you.
 
Difference between Mutually Exclusive Edits and Medically Unlikely edits

Hi Everyone,

I am new to this Coding industry and was researching on NCCI Edits. Can anyone help me with the clear picture as how many core edits are there under NCCI. I came across PTP code pair Edit, Mutually Exclusive Edits, Medically unlikely Edits and Add on code Edits. I am confused between Mutually Exclusive and Medically unlikely Edits.

Please help me correcting my knowledge.
 
IpshitaB said:
Hi Everyone,

I am new to this Coding industry and was researching on NCCI Edits. Can anyone help me with the clear picture as how many core edits are there under NCCI. I came across PTP code pair Edit, Mutually Exclusive Edits, Medically unlikely Edits and Add on code Edits. I am confused between Mutually Exclusive and Medically unlikely Edits.

Please help me correcting my knowledge.
Click to expand...

Mutually exclusive is a PTP edit, where one procedure is considered a component of a more comprehensive code.

MUE is related to the number of units billed on a single date of service of the same code. So its medically unlikely that more than X units would be performed. Example is a code that is per finger, except in extreme cases patient should have only 10 fingers max.
 
So are you finding that with all MUE's [greater than 1 in value] you will need to append the appropriate modifier? Because we are finding a mixture depending on the payer
PER CMS - The appropriate use of HCPCS/CPT modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary
 
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