Follow the correct edit to promote payment and avoid denial. By Samantha Prince, BSHCM, COC, CPC, CPMA National Correct Coding Initiative (NCCI) edits for Medicare and Medicaid are not the same. If you’re following Medicare edits for Medicaid claims, you may have claims denying inappropriately. That’s missed revenue you could capture by applying the correct […]
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This is the way we have always billed it but the edit response McKesson give is:
According to CPT guidelines published by the AMA, "Codes 90476 – 90748 identify the vaccine product only. To identify the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90748 must be used in addition to an immunization administration code(s) 90460-90474." In addition, according to CMS, codes G0008 – G0010 represent vaccine administration only. Thus, these codes may also receive a recommendation for denial when submitted without their primary vaccine or toxoid supply code.
This claim line was recommended for denial because the vaccine product code was not submitted with the appropriate associated vaccine administration code.
Therefore, procedure 90460 is disallowed.
Anyone having this issue or can assist in understanding why and what to do?
I have a denial for a NCCI edit, the tricky part is, the code they are pairing it with is from a different group all together. I’m not sure of the situation, as far as if the patient was seen one place and then decided to come to us or what, but either way, did an E/M visit along with fundus photos and referred the patient out to a specialist for a detached retina. The insurance company is denying due to another code for a similar procedure being done by another provider on the same date of service. I can’t find anything specific in the NCCI edits that talk about this type of situation and in all my years, this is a first!
Any ideas or thoughts on where I can find this specific information?
Thank you in advance :confused:
Good Morning! CMS has now published a current instruction manual for usage of the NCCI “bundling” edits for billing providers. Not only is the manual helpful, but you can also download the latest NCCI bundling edits for your codes FREE OF CHARGE!!! This is a great help to all practices.
According to a recent update in NCCI Edits, the codes 97597 and 97598 can’t be coded together. We think this is the result of a very recent change in CPT and there is a different code in place of the add-on, 97598, that is acceptable according to NCCI Edits. Please, does anyone know what are the acceptable code(s) to be used in place of 97597 and its add-on, 97598?