tci Part B Insider - 2009 Issue 9

READER QUESTION: Know the Differences Between 'Mutually Exclusive' And 'Bundled' Procedures

The differences could affect your reimbursement. Question: Can you explain what the differences are between mutually exclusive and "column 1/column 2" edits that come from the Correct Coding Initiative (CCI)? Answer: Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same beneficiary. For example, CCI lists 61312 (Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural) as mutually exclusive of 61313 (...intracerebral). The payer would not expect that the doctor would perform both types of craniectomy on the same date for the same patient because...

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