NOTE: All in-article links open in a new tab.

Modified Barium Swallow CCI Edit

Published on 

Monday, March 2, 2020

 | RAC Information 
 | FAQ 

Q:

We are getting an edit that CPT codes 92611 (motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (swallowing function with cineradiography / videoradiography) cannot be billed together and no modifier allowed.  Should we only be reporting 92611?

A:

This is another new CCI edit that became effective January 1, 2020. We have received information from NCCI that CMS has since made the decision to revise this edit. The modifier indicator for this code pair will be changed from “0” to “1”. A modifier indicator of “1” indicates an NCCI-associated modifier may be used to bypass the CCI edit under appropriate circumstances.

The changes will be retroactive to January 1, 2020 and will be implemented as soon as technically possible. Providers may choose to delay submission of claims for deleted edits until after the implementation of the replacement edit file with retroactive date of January 1, 2020.

Providers may also choose to appeal claims denied due to the PTP edits to the appropriate MAC including supporting documentation or resubmit claims denied due to the PTP edits after the implementation of the replacement edit file with January 1, 2020 retroactive date, as permitted by the MAC.

Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.