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69631, 69145, and 20926 Inclusive

Kristin Posted Tue 24th of January, 2012 21:31:26 PM

We are having trouble getting CPT 20926 paid when billed with 69631. They are saying it is inclusive. Based on Supercoder there are no bundling issues. The Commercial payers are saying based on "Clear Claim Connections" the CPTs can not be paid separate. Do you have know if she can fight this.

SuperCoder Answered Tue 14th of February, 2012 16:23:59 PM

SuperCoder CCI edits are based on Medicare's NCCI edits and it's eligible for Medicare patient. Some commercial payers are not following Medicare's CCI and they have certain rules and regulations with their own set of edits. Therefore, if you are billing for commercial payers, you can't affray with them, just you have to adopt their specific rules with CCI edits.

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