Wiki 52346 or 52356?

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christine martin

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I may be confusing myself here, but the NCCI edits on these two codes are hard to understand. Procedures were done on the same side. NCCI says both are not reportable, and I understand that. What I don't get is why the higher valued procedure, 52346, looks like it is bundled into the lower valued procedure, 52356. I've seen this in other situations as well.

I have been driving myself crazy trying to find some guidance on this and must be missing it.

Should the 52356 be reported since it is the Column 1 code or is it ok to submit the 52346 since it is higher-valued? If you do that you can then report the stents as well from what I am seeing, since 52332 is not bundled.

Input would be greatly appreciated.
 
There are two ways to bill this clinical scenario.
1. Bill 52346-XU the higher paying code but the bundled code as your primary procedure with the modifier to unbundle the edit and 52356 as the secondary code and receive payment for each code, or
2. Bill 52346 as the primary code and 52356 with the modifier -XU to receive payment in full for the primary code and 50% of the secondary code, the lesser paying code. This was a recent change CMS made to rectify this coding problem.
 
Thanks for the response, but I have to admit I am still confused. I only intended to bill one of the codes since I don't see justification for both to be unbundled ... My concern is that the higher-valued procedure, 52346, appears to be bundled into the lower-valued procedure... how can the more extensive procedure be the lesser-valued one? And in that case, is it ok to bill the higher valued one, even though the NCCI edit says it is the bundled one? The edit would make sense to me if it were the other way around ...
 
If you would like more information on these coding changes where the modifier is on the higher paying code, the bundled code, and you can switch the modifier to either of the paired codes, check General Surgery Coding Alert, April 2019 volume 21, number 4, page 30.
 
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