Bundling CCI Edits

Help Guide for NextGen® Enterprise PM 8

CCI Bundling Anesthesia Edits

Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service. CPT codes describing services that, when performed as part of the anesthesia service, would be considered included in the anesthesia code include the following partia

Help Guide for NextGen® Enterprise PM 8

CCI Bundling Lab Edits

The CPT Manual assigns CPT codes to organ or disease oriented panels consisting of a group of specified tests. If all tests of a CPT defined panel are performed, the provider may bill the panel code or the individual component test codes. The panel codes may be used when the tests are ordered as that panel or if the individual component tests of a panel are ordered separately. For example, if the individually ordered tests are cholesterol (CPT code 82465), triglycerides (CPT code 84478), and HDL cholesterol (CPT code 83718), the service could be billed as a lipid panel (CPT code 80061). The service could not be billed with CPT code 80061 (Lipid Panel) with CPT code 82465 (cholesterol) as the Lipid Panel would include the individual test. An encounter with CPT 80061 and 82465 CPT codes will show on the Claim Production Status report with the following claim edit. Parent topic: Set Up CCI Edits

Help Guide for NextGen® Enterprise PM 8

Bundling CCI Edits

Bundling CCI Edits Bundling CCI Edits Procurement of a rhythm strip (93040 – 93042) is reported in conjunction with an electrocardiogram (93000). The rhythm strip would not be separately reported if it was procured by the same physician performing the interpretation since it is an integral component of the interpretation. Parent topic: Set Up CCI Edits

Help Guide for NextGen® Enterprise PM 8

Set Up CCI Edits

In File Maintenance, select Libraries > Claim Edits > Claim Edits Libraries. Select the applicable claim edit library. The Claim Edit Library Maintenance window appears. Check the appropriate CCI bundling edits as needed. You can set the CCI bundling edits with a severity level based on business practices. Select System > Payers, and then select the applicable payer. The Modify Payer Information window appears. Select the Practice tab, and then the Libraries tab on the bottom of the window. Attach the claim edit library to the payer by selecting a library in the Claim Edit Library field. Select OK. Bundling CCI Edits CCI Bundling Anesthesia Edits CCI Bundling Lab Edits Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

CCI Bundling Anesthesia Edits

Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service. CPT codes describing services that, when performed as part of the anesthesia service, would be considered included in the anesthesia code include the following partia

Help Guide for NextGen® Enterprise PM 8

Set Up CCI Edits

In File Maintenance, select Libraries > Claim Edits > Claim Edits Libraries. Select the applicable claim edit library. The Claim Edit Library Maintenance window appears. Check the appropriate CCI bundling edits as needed. You can set the CCI bundling edits with a severity level based on business practices. Select System > Payers, and then select the applicable payer. The Modify Payer Information window appears. Select the Practice tab, and then the Libraries tab on the bottom of the window. Attach the claim edit library to the payer by selecting a library in the Claim Edit Library field. Select OK. Bundling CCI Edits CCI Bundling Anesthesia Edits CCI Bundling Lab Edits Parent topic: CCI Edits

Bundling CCI Edits

Recommendations

CCI Bundling Anesthesia Edits

CCI Bundling Lab Edits

Bundling CCI Edits

Set Up CCI Edits

CCI Bundling Anesthesia Edits

Set Up CCI Edits

Bundling CCI Edits

CCI Bundling Anesthesia Edits

CCI Bundling Lab Edits

Bundling CCI Edits

Set Up CCI Edits

CCI Bundling Anesthesia Edits

Set Up CCI Edits