Wiki NCCI MUE Edit Denials

[BrandyBurg]

I have two claim denials from BCBSND and they are denied with "service not payable with other service rendered on the same date". When I called BCBS they told me to reference the CMS Correct Coding Initiative NCCI Policy Manual. I have read through it and tried reading over the spreadsheets but still do not understand it.

Example 1:
I am trying to bill knee high compression socks A6530 with thigh high compression socks A6533. They are two different billing codes. I cannot find anywhere that states I cannot bill them on the same date.

Example 2:
I am billing catheters A4352, surgilube A4332 and 2 syringes A4322. Insurance is denying the syringes not payable with other services rendered on the same date.

I would appreciate any help or guidance anyone can give me on how to decipher the NCCI and MUE tables so I can understand these denials.

 

[podcoder70]

Example 1. The thigh high overruled the knee high since it goes past the knee. Can't wear both.
Example 2. If an injection was performed then all syringes etc are included in the payment for injection.

 

[BrandyBurg]

Example 1. The thigh high overruled the knee high since it goes past the knee. Can't wear both.
Example 2. If an injection was performed then all syringes etc are included in the payment for injection.

The answer to example 1 makes sense. I am still confused for example 2. The syringe is being used to flush the catheters. Do I bill the patient or is the price considered bundled with the catheters?

 

[podcoder70]

The answer to example 1 makes sense. I am still confused for example 2. The syringe is being used to flush the catheters. Do I bill the patient or is the price considered bundled with the catheters?

The location where the service is rendered can affect what is billable. Hospitals can charge for a tissue to blow your nose...exaggerating! In general, any syringe used to complete a procedure is included in the CPT for the procedure. Coding for catheter placement is not my specialty.

 

[kdlberg]

My source for this is Noridian, who is one of the biggest MACs, although I don't think they're ND's MAC. (It's just easy to find stuff on their site.)

"Intermittent Irrigation (A4320, A4322, A4217) of Indwelling Catheter: Medical records show irrigation is being performed on a non-routine basis due to the presence of an acute obstruction in the catheter."

So they will pay if the patient needs to irrigate because there's a blockage. They will not pay for supplies to keep it irrigated (e.g., once a week it's flushed.)