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NCCI Edits help needed

  1. #1
    Default NCCI Edits help needed
    Medical Coding Books
    I am trying to determine why an CCI edit would initiate based on the following two examples.

    1. Place of Service is a 22 (outpatient hospital). Procedures 27446 and 29877 were performed during the encounter. According to the CCI edit POS 22 is invalid for procedure 27446. I did further research and found that code 29877 is a component of 27446, but nothing related to the place of service.

    2. Place of Service is an ASC POS 24. Procedures 45378 and 43239 were performed. According to the CCI edit 43239 is disallowed with 45378. I did some research and found that if one procedure is more extensive than the second, the payment to the provider is based off of the first procedure. However, when I place these two codes into an encoder, both are allowed separate payment with the exception of 43239 taking a 50% cutback.

    Could anyone shed light on the CCI edits for place of service and secondary procedure disallow?

    I would appreciate the help.

  2. #2
    I'm afraid I can only give comment on the 27446. 27446 is an inpatient place of service procedure code.

  3. Default 45378 & 43239 ncci
    45378 is a diagnostic lower endoscopy, 43239 is an upper endoscopy with bx; there is no bundling issue or POS issue. What you may have is an ICD diagnosis issue. Make sure the dx codes you are using are covered diagnosis on your Medicare carrier's website for both of these CPT codes.

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