64493 has an RVU of 2.76
27096 has an RVU of 2.08
In the mutually exclusive edit table, 64493 is a column two code to column one code 27096 and modifier is not allowed
This same question arises if 64483 and 62311 is performed at the same level due to their mutually exlcusive status.
Below is from the CPT Network
".......Therefore, based on the above information and in answer to your specific question, since code 62311 includes the injection of non-neurolytic substances, it would not be appropriate to separately report code 64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level"
One would think due to the fact that 64483 has the higher reimbursement, why can't 64483 be reported even though from NCCI standpoint it is column two. It could be questioned can you bill the column two code instead of the column one code when dealing with a mutually exclusive edit pair.
I have looked thru chapter one of the NCCI policy manual, it simply says the code pair can not be reported together. It does say that you have to report the column one code with a mutually exclusive edit pair. Since with your example and other mutually exclusive edits the column two that they bundle has the higher RVU and actually represents the more "comprehensive" service that was provided. Without any documentation within the NCCI policy stating you have to report the column one code, I feel comfortable stating that though you will not be able to report both service, you are not obligated with a mutually exclusive edit to report the column one code.
This is the statement within the manual that supports my interpretation.
"In the latter type of edit the code pair edit simply represents two codes that should not be reported together"
From the NCCI Policy Manual
The CMS developed the NCCI to prevent inappropriate payment of services that should not be reported together. There are two NCCI edit tables: â€śColumn One/Column Two Correct Coding Edit Tableâ€ť and â€śMutually Exclusive Edit Tableâ€ť. Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a column one and column two HCPCS/CPT code. If a provider reports the two codes of an edit pair, the column two code is denied, and the column one code is eligible for payment. However, if it is clinically appropriate to utilize an NCCI-associated modifier, both the column one and column two codes are eligible for payment. (NCCI-associated modifiers and their appropriate use are discussed elsewhere in this chapter.) All edits are included in the â€śColumn One/Column Two Correct Coding Edit Tableâ€ť except those that are based on the â€śmutually exclusiveâ€ť (Chapter I, Section P) and â€śgender-specificâ€ť (Chapter I, Section Q) criteria in which case the edits are included in the â€śMutually Exclusive Edit Tableâ€ť.
When the NCCI was first established and during its early years,the â€śColumn One/Column Two Correct Coding Edit Tableâ€ť was termed the â€śComprehensive/Component Edit Tableâ€ť. This latter terminology was a misnomer. Although the column two code is often a component of a more comprehensive column one code, this relationship is not true for many edits. In the latter type of edit the code pair edit simply represents two codes that should not be reported together. For example, a provider should not report a vaginal hysterectomy code and total abdominal hysterectomy code together.
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