ncci

  1. A

    Wiki CMS Rescinds UDT NCCI Edits

    Good news for my fellow lab billers! CMS has decided to retroactively rescind/delete the urine drug testing NCCI edits back to 7/1/23. I'm not sure what they hoped to accomplish with the edit, but apparently it wasn't the solution they hoped for. If they were looking for ways to put further...
  2. P

    Wiki 92235 & 92134 ncci edit

    Good afternoon, We have a new retina physician in our practice, he has advised cpt 92235 & 92134 are bundled, but I do locate this edit on MEDICARE FIRST COAST NCCI TOOLS nor on the CMS website. Your assistance is appreciated.
  3. N

    Wiki Unrelated E/M with procedure

    Hi, general question... Is it appropriate to bill an E/M -25 when its unrelated to the primary procedure on every visit? It's not bundled due to both codes being unrelated. For example, patient comes in for debridement 11042 on right ankle, but provider treats edema in another area which is new...
    • nittamarable
    • Thread
    • e/m e/m with modifier 25 e/m with procedure evaluation & management followup modifier 25 ncci ncci edits unbundle wound care
    • Replies: 5
    • Forum: E/M
  4. M

    Wiki Can a modifier be added at the request of the insurer even if CMS/AMA guidelines don't require one?

    We have some CPTs that have been denied by an insurance company for "missing modifier". CPT 99291 was paid then the payment was recouped as "within global period". After our appeal, we received a letter that stated "the claim submitted did not have a modifier appended to the E/M service"...
    • mcochran
    • Thread
    • auditing incidental legal modifier mutually exclusive ncci
    • Replies: 2
    • Forum: Modifiers
  5. C

    Wiki NCCI Edit help requested

    Greetings! Looking for everyone's best advice on NCCI edits! I have been certified a couple years now and have basic understanding of NCCI edits - but would like to do a deeper dive and wonder if anyone has great advice, best resource(s), etc. to recommend. How did you get to the best...
  6. K

    Wiki Claims Denying from BCBS for LDL Cholesterol

    We have began getting denials from BCBS regarding the LDL Cholesterol test (CPT 83721) stating that due to NCCI, it is not billable seperate if Triglyceride is >= 400mg/dl. We have never been denied before. Is anyone else having this issue recently? In reading the NCCI edits, this is correct...
  7. B

    Wiki Help Needed: Project and Research Question-Correct an Edit

    Hi everyone, I am stumpt on this preoject/research question below, any assistance would be so greatly helpful :) Thanks so much, Brittany- CPT code 77003 is present under revenue code 320. CPT code 64490 is present under revenue code 360. An NCCI edit is present on code 77003 and reads...
  8. G

    Wiki NCCI Edits

    If an NCCIi edit has been deleted, why can it not be deleted from the list? It seems that the NCCI Edits list is ridiculously long! Is there a reason for them keeping them?
  9. C

    Wiki EBUS Bundling Issue

    Our providers are performing both EBUS biopsies as well as video/direct visualization endobronchial biopsies during the same bronchoscopy session. Per NCCI, we are unable to bill 31625 & 31652 or 31653 together. Also, per NCCI, we are unable to bill 31623-bronchoscopy with bronchial brushings-...
  10. S

    Wiki NCCI edits policy for different surgeons working together

    Dear All: Good day! I have a query regarding the NCCI edits policy for diffrent surgeons working together in same operative session. Eg. Gyn Specialist performed CPT 58150(Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)...
  11. S

    Wiki NCCI Bundling policy for different surgeons

    Dear All: Good day! I have a query regarding the NCCI edits policy for diffrent surgeons working together in same operative session. Eg. Gyn Specialist performed CPT 58150(Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)...
Top