Question Procedure done for exposure

cmacpc

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Hello fellow Ortho Coders:

I have a case that I am working the codes are 27228, 27146 & 27217-The doctor states in the Operative note that 27146 was performed for exposure, I can't seem to find it in the NCCI edits that this can not be billed together. I ran the NCCI edits and all three codes go thru. If I should not be coding the exposure that i need to have a guideline to show the provider. Can someone direct me?

TIA
 

thomas7331

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You can find the reference for this in Chapter 1 of the NCCI Policy Manual, in section C on the medical/surgical package. In paragraph 6: "exposure and exploration of the surgical field is integral to an operative procedure and is not separately reportable...." and in paragraph 7: "If a definitive surgical procedure requires access through diseased tissue (e.g., necrotic skin, abscess, hematoma, seroma), a separate service for this access (e.g., debridement, incision and drainage) is not separately reportable. Types of procedures to which this principle applies include, but are not limited to, -ectomy, -otomy, excision, resection, -plasty, insertion, revision, replacement, relocation, removal or closure."
 

Orthocoderpgu

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I don't have a reference or guideline either but any procedure performed "for exposure" is not billable. What diagnosis would you link to it? In order to bill a procedure it must be a form of treatment.
 
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