Cardiovascular coding with PCI and CPT and NCCI guidelines.
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Tag Archives: NCCI
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 […]
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NCCI Tightens Up Cardio, Lab Edits July 1
Several procedure-to-procedure (PTP) edit changes in the Medicare National Correct Coding Initiative (NCCI) database will go into effect July 1. The quarterly update files are now available on the Centers for Medicare & Medicaid Services (CMS) website. Most of the changes account for new CPT® codes added for 2020 or codes that will be deleted […]
The post NCCI Tightens Up Cardio, Lab Edits July 1 appeared first on AAPC Knowledge Center.
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.
77080 & 77081 NCCI edits?
Anyone familiar with coding dexa scans? Are there any NCCI edits for billing both 77080 & 77081 together when both are done same encounter (same date of service)?
How are you billing- sequencing? modifier?
Any advice &/or reference would be greatly appreciated.
Thanks!
How are you billing- sequencing? modifier?
Any advice &/or reference would be greatly appreciated.
Thanks!
NCCI Question 70000-79999
If a patient had a hip ORIF on 09/21/18 and is now back on 10/20/18 for pain, is the study considered a comparative imagining study and not billable. Ours Docs are dictating status post ORIF.
Thanks!
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?
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?
Fit NCCI Edits into Hospital Chargemaster Before Claims Submission
Scrubbing is the best way to ensure your claims are clean of unbundling overpayments. A hospital finance department should not treat National Correct Coding Initiative (NCCI) edits as irrelevant to inpatient billing simply because payers don’t use the NCCI to edit inpatient claims before payment. Instead, hospitals should institute internal controls to ensure claims are […]
AAPC Knowledge Center
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.
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
What is the inpatient equivalent to NCCI?
What is the inpatient equivalent to the National Correct Coding Initiative edits? The CMS site advises that NCCI applies to Part B only. What are the name of the edits that apply to Part A – inpatient hospital?
Alexandra