Questions About NCCI Edits for Unusual Situations

There have been questions regarding the use of carotid Doppler (93880) being performed on the same day as venous Doppler (93965, 93970, 93971); some insurance companies do not want to reimburse both procedures as it is unusual to perform both with one service period.

National Correct Coding Initiative edits don’t prevent you from reporting these codes together, but the payer may be questioning the medical necessity of performing both services on the same day. Doctors don’t usually order both of these exams for the same patient on the same date of service. If there was a reason and you can show hard documentation as to the necessity of having both procedures performed on the patient on the same day, then you can document the need for the request and show circumstances that required both procedures be performed.

The medical billing industry is non-stop unusual situations for coding and constant judgment calls are necessary. When you have an unusual situation arise with the services rendered to a patient – a good rule of thumb is to show all the documentation you can to show the request was necessary and when in doubt – contact the payer directly and document who you talk to if you were told to file your claim in a specific manner.

If you are tired of chasing the never ending updates and edits to the fast paced world of medical billing, you’re most likely not being fully reimbursed for the services you perform either. It might be time to consider outsourcing your medical billing claims to a partner that will keep up with the changes, advise your office of any coming changes that will affect your practice as well as get you the best reimbursements for the services rendered to patients.

View all Articles by: Melissa Clark, CCS-P