Wiki CCI Edits -Non-Medicare Carrier Rules

[sbellm]

Our billing agency that continually adds "Do not bill if carrier follows CCI edits" to our billing codes. How do most of you handle this?

For example: we are given the following codes on a case - 29881 and 29884-59 ("Do not bill if carrier follows CCI Edits).

Do most of you bill per carrier rules or do you follow CCI edits regardless of the carrier?

Thanks,
Shelley

 

[mmpratt]

Interesting question

It has been my experience that payer edits are more restrictive than NCCI edits so we are not billing for procedures that experience says will be denied no matter what modifier is appended and how the denial is appealed.

For example, BCBS 'code pair edits do not bypass with modifier -59; (10/1/12) will not allow 29875 when billed with 29880, 29881 or 29888. It will be denied as bundled no matter how it is billed (dx is irrelevant) so why bill it in the first place? Knowing that a procedure will be denied artificially inflates charges and increases adjustments.

This is simply my take.