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Topic Title: NCCI Edits, Modifiers and Charging
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Created On: 01/23/2011 02:15 PM

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 01/23/2011 02:15 PM
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16401034

Posts: 1
Joined: 01/23/2011

After listening to the OPPS Final Rule 2011, a question came up regarding the statement that all charges should be reported. However, what should be done when you have an NCCI edit that prevents you from submitting a charge?

Two examples:

1. Basic metabolic panel and comprehensive metabolic panel can't be performed on the same date of service because of NCCI edits. Do you credit the BMP 80048 or do you submit the charge without a CPT code attached. Another option?

2. Wound debridement and application of multi-layer venous wound compression dressing below knee applied to the same wound. CPT codes 11042 and 29581 cause an edit where the 29581 code is considered a component of the debridement code. 3M has advised us that if the dressing is being applied to the same wound, you should not add a modifier to bypass the edit. Do you credit the compression dressing charge, submit the charge without a CPT code attached or is there another option.

Wound care clinic is a hospital based clinic.

At our hospital CPT codes are attached to charge master codes, so it is difficult to know how to get a charge on the account when the CPT code causes an NCCI edit.

Thank you for your help,

Carolyn
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