Definitions

Definitions

Comprehensive Code (Column 1)

Generally represents the major procedure or service when reported with another code.

Component Code (Column 2)

Generally represents the lesser procedure or service. Reimbursement for a component code is considered included in the reimbursement for the comprehensive code when the service is billed by the same provider for the same patient on the same date of service (i.e., reimbursement for the component code will not be made separately from the comprehensive code).

Reversed NCCI

The order of the Comprehensive and Component Codes have been reversed based on the Medicare's Physician Work RVU's when clinically indicated so the code with the higher RVU will be considered the Comprehensive code.

Retained NCCI

The BlueCross BlueShield of Tennessee edit is based on NCCI logic.

Example: Effective 01/01/05, the Centers for Medicare and Medicaid Services (CMS) no longer recognizes CPT ® codes 90780, 90781, 90782, or 90784 under the Medicare Physician Fee Schedule. Although these are valid codes, CMS requires providers to use the HCPCS codes G0345, G0346, G0351, or G0353 instead of the CPT ® codes. As a result, CMS termed the edits for the CPT ® codes and added equivalent edits for the HCPCS codes. BlueCross BlueShield of Tennessee continues to allow providers to bill with either the CPT ® codes or the HCPCS codes. Therefore, the edits related to the CPT ® codes were retained by BlueCross BlueShield of Tennessee.

Page Modified:May 21, 2012