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CCI edits for October

  1. Default CCI edits for October
    Exam Training Packages
    The CCI edits that are coming out for October state that more bundling is going to occur with the codes of 62319 and 64415. We provider these services quite often and I am wondering if anyone knows if this is just for the surgeon and or the anesthesologist?

  2. #2
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    sierra,

    It's my understanding that the October 2009 NCCI update will revise and UNBUNDLE pain management services that were bundled in error in the April 2009 update. We'll have to wait until October (just a few days away) to see the revised NCCI.

    In regards to the specific codes you're asking about 62319 and 64415 -- these codes ARE and will continue to be bundled into all anesthesia/ASA codes, however, they currently have a modifier indicator of "1" which means the code can be unbundled with the -59 modifier if appropriate.

    Julie, CPC

  3. Default
    Thank you, I appreicate your response.

  4. Default CCI Edits
    Could someone tell me what column1 and column2 means in the NCCI of MCR's website? I was taught that my primary code would be for column1 and column2 is for secondary. I have 62311 as prim and 20550 secondary, 62311 got denied as "payment included in allow of basic procedure", 20550 got paid. I was taught and several co-worker coders say the same thing here, that your primary code does not have a modifier put on it. According to MCR that is not true, MCR is wanting me to put a 59 on 62311 to unbundle and they dont care which is major or minor codes thru my eyes, they choice which is major or minor codes at the time of submission. When I pull up 62311(column1) in the NCCI it does not have a bundling issue w/20550, but when I pull up 20550(column1) it does have a edit against 62311. MCR is saying that they go by the major code, which they are saying it is 20550. I have a hard time believing that a TPI is over a epidural injection. Someone please make sense of this...

  5. #5
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    Michelle,

    Column 2 of the CCI indicates all procedure codes that bundle into the Column 1 code. Based on these edits the 62311 is inclusive of 20550 with a modifier status of "1" which means, if appropriate (separately identifiable service), 62311 may be submitted with the -59 modifier and would be paid.

    I agree that the epidural does appear to be the more major procedure, however, the edits are what they are and we have to bill accordingly. At least the current edit with the "1" modifier status allows for payment of both services when billed during the same setting. If your provider stongly disagrees with this edit you can send comments to NCCI. The contact information is available in the Overview section.

    Julie, CPC

  6. #6
    Location
    Everett, WA
    Posts
    886
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    oh, boy, these new edits are really going to be changing the way our office posts charges!! Some of our secondary procedures go the way of the "0" column now with NO modifier allowed! Might make what we billers have to do a little easier, but.......Prior to this, we could justify our charges with documentation for the modifier used.......but now....our provider will not be pleased!!! ---Suzanne

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