Wiki NCCI Edits

[EikaMTGQueen]

If the NCCI edit rules apply to just medicare or are they across the board? Can you submit one way to medicare and another to anthem (for example) I think if you have to put a 59on it to be paid it needs to be questioned.

For another example if Medicare doesnt pay on 19295, but commercial insurances are can you charge them for the 19295? Oh is it Medicare rules for all carriers?

thanks
Erica Ross CIRCC, RCC

 

[Lynda Wetter]

Let me see if i have your question right.
You want to know if 2 procedures are bundled in the CCI edits as being a column 1 & column 2 code, (one being an integral part of the other) You want to know if you can un-bundle them for another payor such as Anthem or Cigna?
If thats your question, I would think NO. If one code is inclusive to another and you have to put a 59 modifier on it, you need to make sure you are not abusing the 59 modifier. And that you are looking at your guidelines for 59.
It would be interesting to hear others opinions on this...