NCCI edits affecting eyelid procedures

National Correct Coding Initiative (NCCI) edits are released quarterly; we recommend practices check them for issues affecting their practices.  In July, 2015, there were edits added which bundle a few common surgery codes for eyelid procedures that were formerly allowed on the same date of service.

Practices and surgeons should be aware that:

• CPT code 67917 (Repair of ectropion, extensive) can no longer be used on claims with either code 67961 or 67966 (Excision and repair of eyelid, involving lid margin, tarsus … ). 
• CPT code 67924 (Repair of entropion, extensive) can no longer be used on claims with either code 67961 or 67966 (Excision and repair of eyelid, involving lid margin, tarsus … ). 

Bundles for CPT code 67961 are new as of July 1; bundles for 67966 are not new, but worth noting. 

Since none of these code combinations will be allowed on a claim of the same date for the same eyelid, choose the code that best describes the work performed.

We note that these NCCI edits directly contravene instructions in CPT, which state:  “For repair of cicatricial ectropion or entropion requiring scar excision or skin graft, see also 67961 et seq)”.   Nonetheless, the edits are in effect for claims to Medicare and other payers who apply NCCI edits.

NCCI edits are a part of Corcoran’s Medicare Condensed Reference Guide, which is updated quarterly in alignment with these NCCI releases.

As always, if you need assistance with training for coding or documentation, or desire a review of your charts or current fees, Corcoran Consulting Group can help.  Visit our website area to learn more about our courses and other valuable resources.

www.corcoranccg.com   (800) 399-6565