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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Is There an NCCI Edit for Those Codes?

Know how to find the answer and improve your clean claims rate. Medicare revises its National Correct Coding Initiative (NCCI) edits on a quarterly basis. As a medical coder, not only must you keep up with these updates to ensure correct coding, but you need to know how to read the edit files. Here are […]

The post Is There an NCCI Edit for Those Codes? appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

CMS PTP Edit Change

Has anyone else seen the CMS MLM Matters # MM11168?

Effective July 1, 2019, "Modifiers 59, XE, XS, XP, and XU are among the NCCI-associated modifiers. The Multi-Carrier System (MCS) currently requires that modifiers 59, XE, XS, XP, or XU be appended to the column two code of a PTP edit to bypass the edit. With the implementation of CR 11168, Medicare will allow modifiers 59, XE, XS, XP, or XU on column one and column two codes to bypass the edit."

https://www.cms.gov/Outreach-and-Edu…ds/MM11168.pdf
https://www.cms.gov/Regulations-and-…ds/R4266CP.pdf

Waiting for the quarterly PTP edit file effective July 1, 2019 to be release to see if there are any changes to the format. Would anyone have any more information than this?

Medical Billing and Coding Forum

Claim denial for NCCI Edit- help please

Hello~

I am wondering if someone would be able to help me with a claim denial. Our practice billed out 99472 with a modifier 25 for the provider. The same day the same provider provided sedation; the sedation code billed out was 00635. The claim for 99472-25 was denied for NCCI edit. The insurance provider stated that it was most likely a wrong modifier?

Thank you, in advance of any suggestions or help you may be able to provide.

Medical Billing and Coding Forum

NCCI Edit 36226 & 69990; 2 different physicians, 2 different OP sessions, same day

Our neurosurgeon performed a crainotomy for a resection of an AVM 61597, 61702 & 69990.
The neuroendovascular IR performed a post op cerebral angiogram 36222 & 36226.
Both procedures were performed on the same day by different physicians within the same group (neurosurgery & neuroendovascular).
We are hitting an edit because the 69990 Microscope can’t be billed with the 36222 nor 36226.
Mind you these are 2 different procedures at different operative sessions on the same day billed independently of each other.
Can we dispute this edit?

Medical Billing and Coding Forum

NCCI Edit – Provider Edits or Edits per TaxID?

Hello!
I have been getting different opinions based on my research for this topic.
I cannot find anywhere specifically showing that the NCCI edit manual edits would only apply to the rendering provider NPI.

We have two different providers in one practice (same tax ID, different NPIs) that are doing the following setup:
One physician performs the procedure.
The other physician administers anesthesia for the procedure.

Both providers are capable of anesthesia, both providers are capable of providing the procedure.
But one provider is not doing both at the same time.
Does that make sense?
We want to know if the anesthesia should be unbundled from the procedure since the provider of the procedure was not the provider of anesthesia even though they share the same Tax ID?

We felt both providers should be reimbursed for their services. Are we wrong in that thinking?

Please let me know if you have references to cite! 😀

Thank you so much for your help in advance!
~Melissa Rufenbarger, CPC

Medical Billing and Coding Forum

Z80.0 clinical edit error BCBS Michigan

Anyone experiencing denials for Z80.0 with BCBS? I’ve run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I’ve talked with provider services, reported the issue and believe since Oct 1st they have an error in their clinical edits. Just curious if other states are encountering similar denials – it’s not all the plans, just a couple to date. G0105 Z80.0 denies and per the reps at BCBS, they told me their database says Z80.0 is not valid, to use another code. I’ve checked Z80.0 and it did not change or get replaced with the 2018 revisions to ICD10. Interested in any input. thx!

Medical Billing and Coding Forum

Can’t clear an edit; 61322 & 61313 done on the same day

Physician billing;

Physician billed a 61322 – CPT® Code in category: (Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma)
Shortly thereafter the patient developed an intracranial bleed requiring a return to the OR the same day for a 61313 – CPT® Code in category: (Craniectomy or craniotomy for evacuation of hematoma, supratentorial)
As per coding guidelines these 2 cpt codes cannot be billed together on the same day. Considering the circumstances I advised to bill the charge with a -78 modifier “unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the post-operative period and appeal if need be.

I’ve been advised to bill 61322 twice with the 76 modifier (Repeat Procedure by Same Physician – is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician) which I’m not comfortable in using because the 2nd OP note does not support this code. It does support the bleed CPT 61313.

I’d like others opinions.

Medical Billing and Coding Forum