Wiki Ncci edits question

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bench

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Hi Fellows,

I am coding for an ASC. My concern is about the NCCI edits. Basically, this is for Medicare only. If you are billing for other insurances like United Health, Blue Cross or Blue Shield, do you also follow this NCCI edits as a basis for guidelines? Example cpt code: 58662 and 58350, with the edits they are inclusive procedure as the 58350 is a "standard of medical/surgical practice" which is not sepearately claimable with Medicare. But with Blue Cross, these codes are getting paid separately. I need your advise please. What would you do in this type of circumstances.

Thanks very much for your input.

Bench
 
I know there are some carriers that don't follow the NCCI rule of thumb. However, I do find this to be a limited few. I compare this ideology to Medicare Global Guidelines versus CPT Global Guidelines...similar but vary slightly. Some carriers follow CPT, some follow Medicare. You'll find some carriers that follow NCCI edits and some develop their own edits. I am, however, VERY surprised that this question pertains to BCBS. In my opinion, they are the most stringent, manipulating carrier arround. I just have to wonder if this is a "system glitch". In any case...yes...you will find some carriers that deviate away from NCCI; although, I do think these carriers are the minority.
 
Just because they are paying it doesn't mean it is correct.. I don't know one way or the other on those codes, but I have seen carriers pay for things that really shouldn't have been.
 
I know with many of our ASC's, unless it is part of our contract with BC/BS, we are paid a case rate no matter how many services are provided, and regardless of CCI edits. BCBS usually posts their medical policies, etc on the web. Also, if you are contracted with the carrier, I would review the contract to see if they apply NCCI ruling or usning their own.

Reacal
 
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