Wiki Questions About Multiple Surgery Reduction with Medicaid

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knperry

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Hi everyone!
I need some clarification on this multiple surgery reduction rule concerning Medicaid. I am aware that when a patient has more then one procedure on the same date a reduction will be applied. I put the cpts codes in order according to RVU's. Medicaid went through and selected the cpts they wanted to pay. Why is this? I thought by me putting the cpts in the order we wanted them paid is the way they would be processed. The codes and the order used are as follows: 44602, 44202, 44180, 49000, 49320. Now I just knew cpt 49000 was going to denied due to ncci edits but Medicaid picked cpt 44202 & 49000 to pay. Does anyone have any knowledge to share on possibly getting cpt codes 44602, 44180 & 49320 paid or do we have to settle for the ones Medicaid selected?

Thank You all for sharing!
 
I don't know if this is the specific problem for you but I found that our billing software would change the order of how the CPT codes are billed out.

You might check if that happened or is happening with your scenario.

I was able to find this out by contacting a few different payers we had billed claims to with the suspected problem. I asked the payer how they show our claim came through. When the way they said it came through didn't match up to the way we had it in our system, my next call was to our billing software support department.

Might be worth looking into...
 
Medicaid multiple procedure

Send a paper red drop out CMS-1500 and send operative notes.
Code 44602(column 1) has a CCI conflict with code 49320(column 2). A modifier is allowed to override this relationship. However, 49320 per CPT has a "separate procedure" designation. It was probably denied as included in the more comprehensive code.
Code 44202(column 1) has a CCI conflict with code 44602(column 2). A modifier is allowed to override this relationship, however the documentation would have to support the use of the modifier to override the NCCI edit. The use of modifier 59 or XS seems appropriate if AT DIFFERENT SITES and the suture was not due to an iatrogenic injury.
Hope this helps.
 
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