![Page 1: NCCI Policy Manual - Amazon Web Servicesaapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/... · NCCI Policy Manual General Surgery Christopher Chandler, MHA, MBA,](https://reader030.vdocument.in/reader030/viewer/2022013002/5e6f3645f0c36d44f3060f9e/html5/thumbnails/1.jpg)
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NCCI Policy Manual
General SurgeryChristopher Chandler, MHA, MBA, CPC, CGSC
Professional Coding ConsultantIntermountain Healthcare
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What is the NCCI Manual?
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How Does It Help?
• Identifies Correct Coding
• Reduce Risk
• Reduce Denials
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Referenced Chapters• Chapter 1 (General Policies)
• Chapter 3 (10000 - 19999)
• Chapter 5 (30000 – 39999)
• Chapter 6 (40000 - 49999)
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CPT Surgical Package
Typical Post-Op Care
Immediate Post-Op
H & P Local Infiltration
Orders
Postanesthesia Evaluation
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NCCI Surgical Package
Typical Post-Op Care
Immediate Post-Op
H & P Local Infiltration
Orders
Postanesthesia Evaluation
Multiple Procedures
Related Procedures
Pre and Post Op Work
Separate Procedures
Post-Op Complications
Anesthesia
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Code Selection
• Choose the most specific code
• All services in description must be
performed
• Don’t report two codes if there is one
code
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Evaluation and Management
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Evaluation and Management
• All surgeries include an E/M
• Exception: If decision for surgery occurs same
day or day before
• Major Procedure (90 days) = Mod. 57
• Minor Procedures (0 & 10 days) = Mod. 25
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Multiple Procedure Overlap• Global package causes overlap when multiple procedures are
reported
• Areas Overlapped:
• Pre/Post Op Care
• Surgical Room
• Staff
• Tools and Equipment
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Multiple Procedure Overlap
Partial Enterectomy
Repair Strangulated
Hernia
Pre-Op, Post-
Op Care, etc.
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Unbundling
19301 – Partial Mastectomy
38525 – Biopsy or excision of lymph
node(s)
19302 – Partial
Mastectomy w/
axillary
lymphadenectomy
10.13 RVU
13.99 RVU
6.43 RVU
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Unbundling
$3.99
$1.79
$1.00
$6.78
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Unbundling
$5.69
Unbundled = $6.78
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Inherent Services
• Services included, but not listed in description of the code:
• Control of bleeding
• Exception – Different encounter
• Iatrogenic injuries
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Inherent Services
Removal of intubation tube
is not separately reportable
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“Separate Procedures”44005 – Enterolysis (freeing of intestinal adhesion) (separate procedure)
• A smaller portion of a much larger procedures
• Does NOT mean it can be billed separately
• Must be performed alone or unrelated to other procedures
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“Separate Procedures”
49000, 49320
44005, 44180
Exploratory Laparotomy
Lysis of Adhesions
Diagnostic Scopes
43191,
43200,
43235,
45300,
45378
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Exploratory Laparotomy
Open Exploratory Laparotomy (49000) = 12.54 RVU
Open Cholecystectomy (47600) = 17.48 RVU
Exploratory Laparotomy + Therapeutic Abdominal Procedure =
Therapeutic Abdominal Procedure
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Lysis of Adhesions
• Always included with other abdominal procedures
• Never report with another abdominal procedure
• Modifier 22 may be used
• “Beyond difficult” case
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Endoscopic Procedures
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Endoscopic Procedures• NOT Separately Reportable:
• To verify placement or no injury
• Performed as an integral part of a larger procedure
• Exception – Diagnostic to determine necessity of larger
procedure
• Code to furthest extent
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Fluoroscopy
• Inclusive of all endoscopic
procedures
• Don’t report for verification of
placement
• Inclusive of all laparoscopic
procedures
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Conversion
First
Approach
Final
Approach
Report Final Approach
Laparoscopic Open
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Anesthesia
Do NOT report local and general
anesthesia if performed by the
same physician providing the
procedure
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Gallbladder Removal
Do not report separately
with hepatectomy code
Do not report separately
with Whipple procedure
code
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Appendectomy• Incidental vs. Medical Necessity
• Open Appendectomy
• 44950 – Appendectomy
• 44955 – Appendectomy for indicated purpose
• 44960 – Appendectomy for ruptured appendix
• Laparoscopic Appendectomy – 44970
• Unlisted Laparoscopic Appendectomy - 44979
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Hernia Repairs• When can you report a hernia repair with another abdominal
procedure?
• Hernia site is not same site as incision for other procedure
• Medically necessary (not incidental)
• Excision of strangulated organ
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Hernia Repair Mesh• Mesh Code +49568
• Mesh is included with the following:
• All open hernia repairs
• All laparoscopic hernia repairs
• Exception - ventral and incisional hernia repairs (49560 – 49566)
• +15777 not used for hernia repairs
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Panniculectomy
Removal of extra
skin
Open Abdominal
Procedure
Panniculectomy
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Biopsy w/ Other Procedure
Separately Reportable
Separate Lesion
Immediate Pathology
Not Separately Reportable
Assess Margins
Post-Op Pathology
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Fistulas
• Partial excision of organ containing fistula should NOT be reported
separately
• Excision of entire organ can be reported separately
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Breast CodingSurgical Margins
• 19120 – 19126
• Excision of cyst, tumor, lesion, etc. w/out
surgical margins
• 19302
• Excision of cyst, tumor, lesion, etc. with
minimal adequate surgical margins
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Lymph NodesReport Separately from Breast Procedure:
• Sentinel Lymph Node Biopsy (38500)
• Contralateral lymph node excision
• Not ipsilateral lymph node excision
For mastectomy with total lymphadenectomy report 19302, 19305, 19306, or 19307
Do not report 38747 with other codes in the op field
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ConclusionAvoid Unbundle
Decrease Denials
Process Improvement
Avoid Risk
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Questions?