The main CCI edits you want to be sure to watch for are those related to new code 96446.
Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)
The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.
For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.
Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.
79200 edit reminds you to check ME edits as well
CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.
Note where 96446 falls (Col. 1/Col. 2) for non-mutually exclusive (NME edits)
The 96446 NME edits are largely what you'd expect based on other chemotherapy code edits – bundles with E/M, anesthesia, venipuncture and other vascular procedures, for instance. You want to be sure to watch which is the column 1 code and which is the column 2 code for these bundles.
For example: CCI places E/M codes 99217-99239 in the column 1 position and 96446 in the column 2 position. On the contrary, CCI places 96446 in the column 1 position and E/M codes 99201-99215 in the column 2 position.
Remember that if you report both codes in an NME edit pair without a modifier, Medicare (as well as payers who adopt these edits) will deny the column 2 code and pay you only for the column 1 code.
79200 edit reminds you to check ME edits as well
CCI Edit also created an ME edit for 96446. ME procedures cannot reasonably be performed at the same anatomic site or patient encounter. The edit places 96446 in column 1 and in column 2 is 79200. This edit also has a modifier indicator of 1; as such you may override the edit with a modifier when clinically appropriate, such as in the case of distinct separately identifiable encounters.
No comments:
Post a Comment