Why this NCCI Edit?

Question:

In the office, one of our physicians, performed 31296-50 (endoscopic dilation frontal sinus), 31295-50 (endoscopic dilation maxillary sinus) and 69706 (endoscopic eustachian tube dilation). The insurance is paying on the 31296 and 31295 but will not pay on the 69706 because Medicare considers it unbundled. Why is the ear procedure is considered bundled?

Answer:

Yes, this is a problem. For some reason, Medicare’s National Correct Coding Initiative (NCCI) edits bundle the new eustachian tube dilation codes with endoscopic sinus codes, and other procedures like a direct laryngoscopy and bronchoscopy. It is not clear to us why NCCI would bundle these very separate procedures. Not only that, but most of the edits do not allow a modifier to override it.

Anyone can express concerns about NCCI edits and request a change. Here is the NCCI Contractor contact information:

National Correct Coding Initiative Contractor
Email:NCCIPTPMUE@cms.hhs.gov
P.O. Box 368
Pittsboro, IN 46167

Fax #: 317-571-1745

Refer to the CMS website for more information about NCCI edits:https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd

*This response is based on the best information available as of 01/27/22.