Mutually Exclusive Procedures – Video

Alicia: Mutually Exclusive Procedures – this is so much fun.

Q: Which one of these procedures is not considered a mutually exclusive procedure? We’re going to talk about, I’m going to show you these and then we’re going to go into the description. A bilateral DM foot exam on a BKA (below knee amputation), mammogram on male patient, PSA (for prostate cancer) on Mrs. Jones, pregnancy test on post-hysterectomy patient.

Mutually Exclusive Procedures – Video

A: I like to say mutually exclusive procedures are codes that just don’t make sense together. Let’s give this example: a patient is in a motorcycle accident and is rushed to the OR with a compound fracture (mostly means that there’s lots of pieces, it’s not quite crushed but there’s lots of pieces there) of the left femur. The surgeon attempts to repair the fracture with pin to stabilize it. However, it is determined that the femur has been crushed and an amputation is performed. You would not bill for the attempt to repair the fracture as well as the amputation, because these codes don’t make sense together.

If in another scenario, if the patient is treated and the surgeon is able to pin that fracture together and pretty much saves the leg, but two weeks later, they come back and there’s trouble with the pedal pulses and maybe infection and the pins is just not setting, it’s not working. Then he goes in and they have to amputate after all; then you can code for the two separate procedures because it wasn’t there on the same day. It was done separately.

Poll: What do you think was the correct answer for which one of these just do not go together? Which one of these procedures is not considered a mutually exclusive procedure?

A.      Bilateral DM foot exam on a BKA (below knee amputation)

B.      Mammogram on male patient

C.      PSA (for prostate cancer) on Mrs. Jones

D.      Pregnancy test on post-hysterectomy patient.

Boyd: If everybody can put their answer in the chat to give us a sense of what you think the answer is.

Alicia:  We want something that just doesn’t go together, and the fact is B is the answer. Because men can get breast cancer and they do, do mammograms on men. But, you’re not going to do a PSA on a woman because she doesn’t have a prostate. You’re not going to do a bilateral foot exam on a person that’s had their below knee amputated, and you’re not going to do a pregnancy test on a woman who doesn’t have a uterus. So, there’s the answer. Mutually exclusive procedures mean when they don’t go together, you wouldn’t put these two codes together because it just doesn’t make any sense. So, now you can picture that woman in the mirror when you think about it. That’s what mutually exclusive procedures mean, they just don’t go together.

Read More Information about Mutually Exclusive Procedures

What are CCI Edits?
AAPC – Mutually Exclusive