Neurosurgery Coding Alert

Nugget: Understanding CCI edits can help reduce denials for neurosurgeons because many of the procedures they perform are controlled by its policies. Unbundling — coding for two or more procedures that should not be billed together — can result in accusations of fraud and denial of payment by Medicare. Through a solid grasp of bundling basics — and specifically, its applications to the intricacies of neurosurgery — neurosurgeons can avoid costly compliance problems. The largest source of bundling combinations or edits is Medicare’s national Correct Coding Initiative (CCI), implemented to protect payers from double payment for the same procedure. Since January 1996, CCI has developed coding policies and more than 120,000 edits for reimbursement compliance to help curb improper billing. Because many of the procedures neurosurgeons perform are guided by CCI policies, understanding these edits and keeping abreast of quarterly changes is particularly important. Mutually Exclusive Codes “Discerning disallowed mutually [...]