2. Go to the NCCI section of the CMS website at https://www.cms.gov/Medicare/Cod

Question

2. Go to the NCCI section of the CMS website at https://www.cms.gov/Medicare/Coding/NationalCorrectCodIn itEd/index.html. Select PTP Coding Edits from the left menu tray. Select the most current version of the Hospital PTP Edits and open the file containing Column 1 code 37213. Scenario: You are reviewing pre-billing claims and observe that the following claims are failing for mutually exclusive code edit. Review the PTP edit file and explain how you would address each of the issues. Code 1 Code 2 Claim 1 37217 93050 Claim 238794 69990 Claim 3 11306 12034 Claim 435518 35587

Explanation / Answer

Claim 1

code 1 37217 represents other transcatheter procedures that are surgical procedures in arteries and veins.

code 2 93050 shows the procedure was done under cardiography.

Claim 2

Code 1 39794 represents introduction procedure on the lymph nodes and lymphatic channels.

Code 2 69990 shows the procedure done under an operating microscope.

Claim 3

Code 1 11306 represents shaving of the epidermal lesion or dermal lesion, single lesion, scalp, neck, hands, feet, and genitalia.

Code 2 12034 Repair, intermediate wounds of scalp, axillae, trunk and or extremities.

Claim 4

Code 1 35518 Bypass graft with vein.

Code 2 35587 In-situ vein Bypass.

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