Just-in codes appear in Non-mutually exclusive pairs
Non-mutually exclusive edits apply to services that a doctor may carry out during the same care session but that are not billable together. The reason is one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.
The latest CCI includes non-mutually exclusive edits for virtually every anesthesia code when carried out with various new CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session:
Non-mutually exclusive edits apply to services that a doctor may carry out during the same care session but that are not billable together. The reason is one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.
The latest CCI includes non-mutually exclusive edits for virtually every anesthesia code when carried out with various new CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session:
0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe
0253T -- Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space
31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example, fibrin glue], if performed
43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example., for gastrointestinal hemorrhage), including lavage if performed
43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example., acid analysis).
The same edits apply to anesthesia during three catheter and coronary angiography procedures:
The same edits apply to anesthesia during three catheter and coronary angiography procedures:
93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when carried out
93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.
Exceptions: Each edit pair carries a modifier indicator of "1,"which means you can sometimes bypass the edit by filing the right modifier. See to it that you have enough supporting documentation to justify payment for both codes before filing with a modifier, say for instance 59 (Distinct procedural service).
Forget subsequent care with anesthesia
This time CPT introduces three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient …). The latest CCI edits clarify that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of "0", meaning you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you will get an automatic denial.
Article Source :- http://isupercoder.blogspot.in/2011/01/in-cci-170-anesthesia-overrides.html
Exceptions: Each edit pair carries a modifier indicator of "1,"which means you can sometimes bypass the edit by filing the right modifier. See to it that you have enough supporting documentation to justify payment for both codes before filing with a modifier, say for instance 59 (Distinct procedural service).
Forget subsequent care with anesthesia
This time CPT introduces three new codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the evaluation and management of a patient …). The latest CCI edits clarify that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of "0", meaning you cannot report the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you will get an automatic denial.
Article Source :- http://isupercoder.blogspot.in/2011/01/in-cci-170-anesthesia-overrides.html
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Anesthesia Billing Services