Wiki correct coding issue

[trishj12]

I am currently in a discussion regarding codes entered on a claim when NCCI does not allow payment when billed certain codes are billed together. Example: billing 49000, lysis of adhesions, and billing 44120, enterectomy, or with a choleycystectomy. One opinion is that the claim should reflect the procedures performed for "coordination of care". Another opinion is that certain codes are inherently a part of some codes as indicated by NCCI edits and correct coding should not list a code as part of another code. Please help with supporting evidence and your professional opinions.

Thank you!

 

[Pam Warren]

Follow your NCCI edits. Unbundling your charges specifically for internal reporting purposes is a bad idea. If you want to do quality measures to report adjunct procedures or therapies that are inherently part of the major procedure, find another way to do this other than to post it as a billable survice. Coordination of care should be reported through internal documentation, not dropped to a claim form.

 

[FTessaBartels]

Separate Procedure

Please note that most CPT-defined separate procedures (like 49000) will NOT be on the CCI edits becaause, by definition, they are to be coded only when they stand alone.

Hope that helps.

F Tessa Bartels, CPC, CEMC