awhalen
New
I have always understood that for HOPD reimbursement, payment for multiple procedures is dictated by both NCCI edits and the SI of the procedure. When you have multiple procedures (assuming there is no NCCI issue, where there are not in our situation) on the same HOPD claim, CMS will look at the SI to determine if a reduction is applied. In the specific scenario I am looking at we have 3 codes, with S, S, and T SI’s respectively. This results, in my understanding, in no payment reduction. Here is the reference I have always used for validation, but its now over a decade old, and I am having a hard time finding current validation.
One of our external coding sites reports that the T procedure IS reduced in this sitaution, which is contradictory to my understanding, but I can’t find another reference that discusses how the S/T combination are paid. Any thoughts?
One of our external coding sites reports that the T procedure IS reduced in this sitaution, which is contradictory to my understanding, but I can’t find another reference that discusses how the S/T combination are paid. Any thoughts?