New NCCI Edits for Orthopedic Codes

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By: Jacqueline Thelian, CPC, CPC-I, CHCA
Medco Consultants, Inc

As you know the National Correct Coding Initiative (NCCI) edits define pairs of CPT/HCPCS codes that should not be reported together for a variety of reasons. 

The latest version of NCCI edits V23.3 effective October 1, 2017 targets shoulder procedures. Now CCI will bundle shoulder release code 23020 into arthroplasty 23470-23474 codes. This means it would be inappropriate to report the two codes for the same shoulder. You may however, unbundle and report them on the opposite shoulders.

Additionally, Chapter 4 of the NCCI edits state, “When a fracture or dislocation is repaired, only one fracture/dislocation repair code may be reported. Closed repair codes, percutaneous repair codes, and open repair codes for the same anatomic site are mutually exclusive of one another, and only one of these codes may be reported for the repair of a fracture or dislocation at an anatomic site.”

Once again separate billing would only be appropriate when these services are provided on opposite shoulders.