NCCI or National Correct Coding Initiative — VIDEO

My turn, we had a question come in from someone who’s using Super Coder so they’re doing some research and they came across some statements on this particular article. Let me see if I can pull that up successfully.

This is SuperCoder.com, if you go to CodingCertification.Org/supercoder  that will talk you to their page with different pricing information. But this is a very good encoder, one of my favorites. I like SuperCoder and FindACode, and there’s a third where I’m going to be doing a review of my three favorites so people can see how I use them.

We met them at a conference, did we not, for the first time? Yes, she’s a great gal.

Yup. Jenny came over. And I love Super Coder; they had a great booth there.

Down on the bottom, it’s talking about these two codes. This is what she’s talking about this statement here. Let me show you in the answer sheet how we work this out. On the bottom of the page where I just showed you, the scenario describes both impedance and pH test being performed in one session. “If you think coding it is as easy as billing 91038 and 91034, you’re wrong.” – So she’s quoting the article. “Dodge a potential audit by looking into another important factor CCI Edits…” It goes on to talk about these two codes. She is confused by the articles.

National Correct Coding Initiative – VIDEO

What I want to do is show you I do CCI Edit kind of research for myself to see if there’s a bundling issue and how I chose which code to report. So, I‘m going to grab these two codes and I’m going to back to my SuperCoder. Up on the top when you pay for this, you’ll get things like CCI Edit Checker. You just go in and in this box, you put in your codes and you need to separate them by a comma instead of the word “and” and you just click on “validate”.

So, here’s the two codes, 91038 and 91034. We’ve got this red big flag. So this is telling me, “Nah-ah, I’m not going to get away with coding both.” So, I’m going to read what the box says and it says, “The 91038 is a column two code for 91034. These codes cannot be billed together in any circumstance. Code 91038 is bundled into 91034. Code 91038 cannot be billed with 91034.”

Basically what I do is I look at the RVUs. This one is worth 14.50 RVUs. This one is worth 5.93. So, depending on where you live and whatever, this gets multiplied times a conversion factor to come up with the dollar amount. The higher the RVU, the more money the code is worth. I normally, when I have between two codes, we’ll go with the higher code, the 91038 because it’s worth 14.50 RVUs.

That’s what you’re looking for. If your documentation sounds like it supports both, and you pop up both of those codes into your CCI Edit Checker and it comes up as you can’t bill both of them together, then bill the more comprehensive one. So, the smaller or lesser RVU one is the one that’s bundled into it.

Let me go back to the rest of my answer. So this is what she was struggling with. I just kind of comparing the two codes here to see visually what they share in common, so in green, I did that. They both say gastroesophageal reflux test with nasal catheter. They both say recording analysis and interpretation. The 038 code, the higher RVU one is called an esophageal function test and it’s little, apparently more involved that talk about greater than one hour, etc.

So, if your documentation supports greater than one hour etc., then go with the 91038 and do not report the 91034. Or else you would be violating the CCI Edit.

This sentence here should be reversed. Check out the CCI Edit’s table and you’ll see 91034 described as the more extensive code. It actually should say 91038 is the more extensive code. So I can see why that would have tripped someone up. So focus on the RVU values and you just need to ask yourself: Does my documentation support the higher RVU one? If that’s the case, then go ahead and report that and forego the lesser RVU one.

More National Correct Coding Initiative Related Posts:

• CCO – Facility Based Coding Course
• AAPC – NCCI Change