AAPC - August DL Sale: 50% OFF
Results 1 to 4 of 4

Thread: Ncci edits question

  1. #1
    Join Date
    Apr 2007
    Posts
    79

    Default Ncci edits question

    Hi Fellows,

    I am coding for an ASC. My concern is about the NCCI edits. Basically, this is for Medicare only. If you are billing for other insurances like United Health, Blue Cross or Blue Shield, do you also follow this NCCI edits as a basis for guidelines? Example cpt code: 58662 and 58350, with the edits they are inclusive procedure as the 58350 is a "standard of medical/surgical practice" which is not sepearately claimable with Medicare. But with Blue Cross, these codes are getting paid separately. I need your advise please. What would you do in this type of circumstances.

    Thanks very much for your input.

    Bench

  2. #2
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,127

    Default

    I know there are some carriers that don't follow the NCCI rule of thumb. However, I do find this to be a limited few. I compare this ideology to Medicare Global Guidelines versus CPT Global Guidelines...similar but vary slightly. Some carriers follow CPT, some follow Medicare. You'll find some carriers that follow NCCI edits and some develop their own edits. I am, however, VERY surprised that this question pertains to BCBS. In my opinion, they are the most stringent, manipulating carrier arround. I just have to wonder if this is a "system glitch". In any case...yes...you will find some carriers that deviate away from NCCI; although, I do think these carriers are the minority.

  3. #3

    Default

    Just because they are paying it doesn't mean it is correct.. I don't know one way or the other on those codes, but I have seen carriers pay for things that really shouldn't have been.

  4. #4

    Default

    I know with many of our ASC's, unless it is part of our contract with BC/BS, we are paid a case rate no matter how many services are provided, and regardless of CCI edits. BCBS usually posts their medical policies, etc on the web. Also, if you are contracted with the carrier, I would review the contract to see if they apply NCCI ruling or usning their own.

    Reacal

Similar Threads

  1. NCCI edits/ global question
    By nlaaron in forum Modifiers
    Replies: 6
    Last Post: 03-17-2015, 09:32 AM
  2. NCCI edits
    By wyss.kathy@comcast.net in forum Billing/Reimbursement
    Replies: 1
    Last Post: 09-04-2013, 01:35 PM
  3. NCCI edits vs Mutually exclusive edits
    By uhlerclarem in forum Medicare Regulations
    Replies: 1
    Last Post: 10-27-2010, 05:33 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.