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Tag Archives: Edit

NCCI Edit – Provider Edits or Edits per TaxID?

Hello!
I have been getting different opinions based on my research for this topic.
I cannot find anywhere specifically showing that the NCCI edit manual edits would only apply to the rendering provider NPI.

We have two different providers in one practice (same tax ID, different NPIs) that are doing the following setup:
One physician performs the procedure.
The other physician administers anesthesia for the procedure.

Both providers are capable of anesthesia, both providers are capable of providing the procedure.
But one provider is not doing both at the same time.
Does that make sense?
We want to know if the anesthesia should be unbundled from the procedure since the provider of the procedure was not the provider of anesthesia even though they share the same Tax ID?

We felt both providers should be reimbursed for their services. Are we wrong in that thinking?

Please let me know if you have references to cite! 😀

Thank you so much for your help in advance!
~Melissa Rufenbarger, CPC

Medical Billing and Coding Forum – Medicare Regulations