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Old 12-11-2012, 03:11 PM
ms123 ms123 is offline
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Default 15823 and 67904 on same eye

We have patients who have the levator resection (67904) and the excision of excess skin/fat (15823) done on the SAME EYE. For Medicare, there is an NCCI bundle, so only one code can be submitted. 15823 has the higher RVU, thus that one should be coded for Medicare, correct? But for COMMERCIAL payers, can both 15823 59 and 67904 59 be submitted? Is there a policy stating any of this?

Any response will be greatly appreciated.
Thank you.
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Old 02-10-2013, 11:21 PM
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Should help you with your question
Sal Valdepena, CCS, CEDC
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Old 02-11-2013, 10:04 AM
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mitchellde mitchellde is offline
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since most if not all commercial payers also follow the CCI edits then I would say no you cannot bill both, you are allowed to bill the procedure with the higher RVU, but be sure you have it correct.

Debra A. Mitchell, MSPH, CPC-H
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