Forum - Questions & Answers

Aug 17th, 2018 - Hhiba

Grouping of mutually exclusive CPt4 in IR DRG

An I know mutually exclusive edits from NCCI is for fee for service is it applicable in DRG payment also .
For example now I have inpatient admission for patient with acute respiratory failure provider claiming for long term mechanical ventilation . Cpt4 94002 initiation of ventilation and the subsequent 94003 for 10 days . Now provider document all the activities done in the admission .on the same days of the ventilation codes providers document the inpatient E/M codes initial and subsequent , now can I group 94002 and 94003 or I will not group and I say that 94002 and 94003 can't be reported with E/M on the same day.

Oct 30th, 2018 - DWare 3 

re: Grouping of mutually exclusive CPt4 in IR DRG

An edit exists with 94002 and 94003, NCCI results "Edit exists with 94002. 94003 is a Column 2 code. If both 94002 and 94003 are submitted, only 94002 will be paid." You can bill an E/M code if it is a separate reason for the encounter, using an appropriate modifier.

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