Use of NCCI edit in Radiology for Medical coders

Use of NCCI edit with Procedure codes

We know that there are few procedures, which have to be coded with modifiers to provide extra information regarding the procedure performed. As there are many procedures can be done on same day if the diagnosis is not by found easily, hence is such can procedures overlap each other and the payment to the physician is affected. So, to solve this overlap condition we use modifiers to modify the procedure and give certain critical information performed before, during or after the procedures. Let us understand these things with few examples.

Tips when to use CCI edit in Radiology

Read also: When to use Modifier 58, 78 and 79 with CPT codes

In radiology coding, we code X rays of chest, abdomen, extremities, spine etc. and sometimes we come across many CCI edit situations. The most common, which I have come across, is with X rays of chest. Whenever there is two view of chest 71046 performed with one view of chest 71045 on same day, there is CCI edit involved. So in such cases we use 59 modifier to bypass the edit with low RVU cpt that is one view of chest x ray 71045.

71045 Radiologic examination, chest; single view

               

71046 2 views

Also, there are few procedures like x ray of right hand for three views (CPT code 73130,RT) and x ray of right finger for 2 views (CPT code 73140,RT) of same side performed on same day. When we code both procedures together, there is CCI edit between these procedures. Because the hand involves finger as well it is obvious why there is need of performing another separate procedure for finger X ray. So, to bypass the CCI we have to use 59 or X{EPSU} modifier here with X ray of finger 73140. Hence, in such cases we have to more careful when to use CCI edit with CPT codes.

73130 Radiologic examination, hand; minimum of 3 views

73140 Radiologic examination, finger(s), minimum of 2 views

When not to used modifier with procedure code

There are few cases when we are not allowed to add any modifier to any procedure because that whole procedure is involved in the primary procedure. So, if such the main primary procedure will be only paid even if you the other procedure. The secondary procedure will get denied when it is totally inclusive in the primary procedure. Let understand with and example.

For modified barium swallow 74230 and Normal Barium swallow 74220, when performed on same day in same setting; we are not allowed to use any modifier with the procedure code. Normal barium swallow is a part of Modified barium swallow hence it is totally inclusive or a combine exam with modified barium swallow hence cannot be paid separately with Modified barium swallow. So, be careful while coding Normal barium swallow along with modified barium swallow since both cannot be coded together as per coding guidelines.

9 Thoughts to “Use of NCCI edit in Radiology for Medical coders”

  1. […] here only about XE modifier. The XE modifier stands for X- Encounter. This modifier is used to differentiate between the two procedures with different encounter under same physician. Since, many of us are new to using these modifiers […]

  2. […] do remember to use modifier XU with cpt code 77081. Since coding both cpt code together have a CCI edit which is bypassed by using XU […]

  3. […] 76000 is most of the times included in the radiology procedures codes. So, coders should check the CCI edit whether CPT code 76000 is inclusive or not with the primary radiology procedure. If the fluoroscopy […]

  4. […] Radiology, diagnosis related to pelvic region are very common to code. For example, for ovary cyst, pelvic […]

  5. […] the real time ultrasound exam. Therefore, while coding the cpt for Doppler and ultrasound we have CCI edit between […]

  6. […] Radiology procedures are very useful for studying any structure of the body. Brain, which is a very vital part of human body, is also studied very carefully using radiology techniques. Having knowledge about anatomy and physiology helps in coding ICD 10 and CPT codes. If you are perfect in coding medical report, it will helps in preparing for certification exam like CPC without taking any training.  MRI, a three-dimensional scan to study any structure of body, is also used for studying head or brain. In MRI, a dye or a contrast can also be introduced to study the particular area of the body. We have separate CPT code for MRI brain or head with or without using of contrast. We will just learn how to use these CPT codes for coding Radiology medical charts. […]

  7. […] radiology coding, we usually come across CT,CTA, MRI, X-ray reports etc. charts which are very common in […]

  8. […] scan for Lumbar spine is done very frequently in radiology. There are common signs and symptoms for performing MRI exam of lumbar spine like Lumbago or low […]

  9. […] care, regardless of how many times venipuncture is performed. This instruction comes from the 2018 National Correct Coding Initiative (NCCI) Policy Manual, Chapter V: Respiratory, Cardiovascular, Hemic and Lymphatic Systems CPT Codes […]

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