All Edits w/Rationale - 50000 - BlueCross BlueShield of Tennessee

Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50010 37202 NCCI 50010 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 50010 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50010 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50010 44955 BCBST OB-GYN procedure -- standard subset procedure rationale. 50010 49000 NCCI 50010 49002 BCBST 50010 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50010 51701 NCCI Standards of medical/surgical practice 50010 51702 NCCI Standards of medical/surgical practice 50010 51703 NCCI Standards of medical/surgical practice 50010 60540 NCCI NCCI HCPCS/CPT separate procedure definition 50010 60545 NCCI NCCI HCPCS/CPT separate procedure definition 50010 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 64416 NCCI NCCI Refer to Specific Guidelines 50010 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50010 90775 NCCI Standards of medical/surgical practice 50010 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50020 36000 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 50020 36425 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 37202 NCCI 50020 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 38770 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 44602 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 44604 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50020 44955 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 47100 BCBST OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 1 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50020 49000 NCCI 50020 49002 BCBST 50020 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50020 49020 NCCI NCCI Mutually exclusive procedures 50020 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 49320 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 49570 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 50010 NCCI NCCI Standards of medical / surgical practice 50020 50205 NCCI NCCI Most extensive procedures 50020 51700 BCBST 50020 51701 NCCI Standards of medical/surgical practice 50020 51702 NCCI Standards of medical/surgical practice 50020 51703 NCCI 50020 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58660 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58740 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58800 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58805 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58820 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58822 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58823 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 58900 BCBST OB-GYN procedure -- standard subset procedure rationale. 50020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 64416 NCCI NCCI Refer to Specific Guidelines 50020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50020 90775 NCCI Standards of medical/surgical practice 50020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50021 36000 BCBST 50021 37202 NCCI 50021 49061 NCCI 50021 49080 BCBST NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code NCCI Mutually exclusive procedures OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 2 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50021 49424 NCCI NCCI HCPCS/CPT separate procedure definition 50021 51701 NCCI Standards of medical/surgical practice 50021 51702 NCCI Standards of medical/surgical practice 50021 51703 NCCI Standards of medical/surgical practice 50021 51705 BCBST 50021 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 64416 NCCI NCCI Refer to Specific Guidelines 50021 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50021 77002 NCCI HCPCS/CPT coding manual instruction/guideline 50021 90775 NCCI Standards of medical/surgical practice 50021 93000 NCCI Standards of medical/surgical practice 50021 93005 NCCI Standards of medical/surgical practice 50021 93010 NCCI Standards of medical/surgical practice 50021 93040 NCCI Standards of medical/surgical practice 50021 93041 NCCI Standards of medical/surgical practice 50021 93042 NCCI Standards of medical/surgical practice 50021 94770 NCCI Standards of medical/surgical practice 50021 99143 NCCI HCPCS/CPT coding manual instruction/guideline 50021 99144 NCCI HCPCS/CPT coding manual instruction/guideline 50021 99145 NCCI HCPCS/CPT coding manual instruction/guideline 50021 99148 NCCI Standard preparation/monitoring services for anesthesia 50021 99149 NCCI Standard preparation/monitoring services for anesthesia 50021 99150 NCCI Standard preparation/monitoring services for anesthesia 50021 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50040 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50040 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50040 49002 NCCI NCCI Standards of medical / surgical practice 50040 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50040 50010 NCCI NCCI Standards of medical / surgical practice 50040 50020 NCCI NCCI Most extensive procedures 50040 50045 NCCI NCCI Mutually exclusive procedures OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 3 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50040 50541 NCCI NCCI Most extensive procedures 50040 51701 NCCI Standards of medical/surgical practice 50040 51702 NCCI Standards of medical/surgical practice 50040 51703 NCCI Standards of medical/surgical practice 50040 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 64416 NCCI NCCI Refer to Specific Guidelines 50040 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50040 90775 NCCI Standards of medical/surgical practice 50040 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50045 36000 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 50045 36425 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 37202 NCCI 50045 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 44602 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 44604 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50045 44955 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 49000 NCCI 50045 49002 BCBST 50045 49010 NCCI 50045 49080 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 49320 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 49570 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 50010 NCCI NCCI Standards of medical / surgical practice 50045 50020 NCCI NCCI Most extensive procedures 50045 50541 NCCI NCCI Refer to Specific Guidelines 50045 50541 NCCI NCCI Most extensive procedures 50045 50541 NCCI NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 4 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50045 51700 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 51701 NCCI Standards of medical/surgical practice 50045 51702 NCCI Standards of medical/surgical practice 50045 51703 NCCI Standards of medical/surgical practice 50045 51705 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 58740 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 58805 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 58822 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 58900 BCBST OB-GYN procedure -- standard subset procedure rationale. 50045 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 64416 NCCI NCCI Refer to Specific Guidelines 50045 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50045 90775 NCCI Standards of medical/surgical practice 50045 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50060 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50060 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50060 49002 NCCI NCCI Standards of medical / surgical practice 50060 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50060 50020 NCCI NCCI Most extensive procedures 50060 50040 NCCI NCCI Most extensive procedures 50060 50045 NCCI NCCI Most extensive procedures 50060 50500 NCCI NCCI Standards of medical / surgical practice 50060 51701 NCCI Standards of medical/surgical practice 50060 51702 NCCI Standards of medical/surgical practice 50060 51703 NCCI Standards of medical/surgical practice 50060 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 64416 NCCI NCCI Refer to Specific Guidelines 50060 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 5 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50060 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50060 90775 NCCI Standards of medical/surgical practice 50060 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50065 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50065 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50065 49002 NCCI NCCI Standards of medical / surgical practice 50065 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50065 50020 NCCI NCCI Most extensive procedures 50065 50040 NCCI NCCI Most extensive procedures 50065 50045 NCCI NCCI Most extensive procedures 50065 50075 NCCI NCCI Mutually exclusive procedures 50065 50500 NCCI NCCI Standards of medical / surgical practice 50065 51701 NCCI Standards of medical/surgical practice 50065 51702 NCCI Standards of medical/surgical practice 50065 51703 NCCI Standards of medical/surgical practice 50065 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 64416 NCCI NCCI Refer to Specific Guidelines 50065 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50065 90775 NCCI Standards of medical/surgical practice 50065 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50070 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50070 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50070 49002 NCCI NCCI Standards of medical / surgical practice 50070 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50070 50020 NCCI NCCI Most extensive procedures 50070 50040 NCCI NCCI Most extensive procedures 50070 50045 NCCI NCCI Most extensive procedures 50070 50065 NCCI NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 6 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50070 50075 NCCI NCCI Mutually exclusive procedures 50070 50500 NCCI NCCI Standards of medical / surgical practice 50070 51701 NCCI Standards of medical/surgical practice 50070 51702 NCCI Standards of medical/surgical practice 50070 51703 NCCI Standards of medical/surgical practice 50070 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 64416 NCCI NCCI Refer to Specific Guidelines 50070 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50070 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50070 90775 NCCI Standards of medical/surgical practice 50070 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50075 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50075 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50075 49002 NCCI NCCI Standards of medical / surgical practice 50075 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50075 50020 NCCI NCCI Most extensive procedures 50075 50040 NCCI NCCI Most extensive procedures 50075 50045 NCCI NCCI Most extensive procedures 50075 50500 NCCI NCCI Standards of medical / surgical practice 50075 51701 NCCI Standards of medical/surgical practice 50075 51702 NCCI Standards of medical/surgical practice 50075 51703 NCCI Standards of medical/surgical practice 50075 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 64416 NCCI NCCI Refer to Specific Guidelines 50075 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50075 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 7 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50075 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50080 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 50382 NCCI Misuse of column 2 code with column 1 code 50080 51701 NCCI Standards of medical/surgical practice 50080 51702 NCCI Standards of medical/surgical practice 50080 51703 NCCI Standards of medical/surgical practice 50080 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 64416 NCCI NCCI Refer to Specific Guidelines 50080 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50080 77002 NCCI HCPCS/CPT "separate procedures" definition 50080 90775 NCCI Standards of medical/surgical practice 50080 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50081 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 50382 NCCI Misuse of column 2 code with column 1 code 50081 51701 NCCI Standards of medical/surgical practice 50081 51702 NCCI Standards of medical/surgical practice 50081 51703 NCCI Standards of medical/surgical practice 50081 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 64416 NCCI NCCI Refer to Specific Guidelines 50081 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50081 77002 NCCI HCPCS/CPT "separate procedures" definition 50081 90775 NCCI Standards of medical/surgical practice 50081 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50100 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 8 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50100 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50100 49002 NCCI NCCI Standards of medical / surgical practice 50100 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50100 50020 NCCI NCCI Most extensive procedures 50100 51701 NCCI Standards of medical/surgical practice 50100 51702 NCCI Standards of medical/surgical practice 50100 51703 NCCI Standards of medical/surgical practice 50100 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 64416 NCCI NCCI Refer to Specific Guidelines 50100 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50100 90775 NCCI Standards of medical/surgical practice 50100 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50120 36000 BCBST 50120 37202 NCCI 50120 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 44602 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 44604 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50120 44955 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 49000 NCCI 50120 49002 BCBST 50120 49010 NCCI 50120 49080 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 49320 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 49570 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 50020 NCCI 50120 50045 BCBST 50120 50544 NCCI NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Most extensive procedures OB-GYN procedure -- standard subset procedure rationale. NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 9 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50120 51700 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 51701 NCCI Standards of medical/surgical practice 50120 51702 NCCI Standards of medical/surgical practice 50120 51703 NCCI Standards of medical/surgical practice 50120 51705 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 58805 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 58900 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 58960 BCBST OB-GYN procedure -- standard subset procedure rationale. 50120 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 64416 NCCI NCCI Refer to Specific Guidelines 50120 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50120 90775 NCCI Standards of medical/surgical practice 50120 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50125 37202 NCCI 50125 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 50125 38765 BCBST OB-GYN procedure -- standard subset procedure rationale. 50125 38770 BCBST OB-GYN procedure -- standard subset procedure rationale. 50125 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50125 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50125 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50125 49000 NCCI 50125 49002 BCBST 50125 49010 NCCI 50125 49255 BCBST 50125 50020 NCCI NCCI Most extensive procedures 50125 50120 NCCI NCCI Most extensive procedures 50125 50544 NCCI NCCI Most extensive procedures 50125 50600 BCBST 50125 51701 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 10 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50125 51702 NCCI Standards of medical/surgical practice 50125 51703 NCCI Standards of medical/surgical practice 50125 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 64416 NCCI NCCI Refer to Specific Guidelines 50125 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50125 90775 NCCI Standards of medical/surgical practice 50125 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50130 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50130 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50130 49002 NCCI NCCI Standards of medical / surgical practice 50130 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50130 50020 NCCI NCCI Most extensive procedures 50130 50120 NCCI NCCI Most extensive procedures 50130 50125 NCCI NCCI Most extensive procedures 50130 50544 NCCI NCCI Most extensive procedures 50130 51701 NCCI Standards of medical/surgical practice 50130 51702 NCCI Standards of medical/surgical practice 50130 51703 NCCI Standards of medical/surgical practice 50130 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 64416 NCCI NCCI Refer to Specific Guidelines 50130 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50130 90775 NCCI Standards of medical/surgical practice 50130 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50135 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 11 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50135 38765 BCBST OB-GYN procedure -- standard subset procedure rationale. 50135 38770 BCBST OB-GYN procedure -- standard subset procedure rationale. 50135 38780 BCBST OB-GYN procedure -- standard subset procedure rationale. 50135 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50135 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50135 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50135 49000 NCCI 50135 49002 BCBST 50135 49010 NCCI 50135 49255 BCBST 50135 50020 NCCI NCCI Most extensive procedures 50135 50120 NCCI NCCI Most extensive procedures 50135 50125 NCCI NCCI Most extensive procedures 50135 50130 NCCI NCCI Most extensive procedures 50135 50544 NCCI NCCI Most extensive procedures 50135 51701 NCCI Standards of medical/surgical practice 50135 51702 NCCI Standards of medical/surgical practice 50135 51703 NCCI Standards of medical/surgical practice 50135 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 64416 NCCI NCCI Refer to Specific Guidelines 50135 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50135 90775 NCCI Standards of medical/surgical practice 50135 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50200 10021 NCCI NCCI Sequential procedures 50200 10022 NCCI NCCI Sequential procedures 50200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50200 50205 NCCI NCCI Mutually exclusive procedures 50200 51701 NCCI Standards of medical/surgical practice 50200 51702 NCCI Standards of medical/surgical practice 50200 51703 NCCI Standards of medical/surgical practice NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 12 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 64416 NCCI NCCI Refer to Specific Guidelines 50200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50200 90775 NCCI Standards of medical/surgical practice 50200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50205 10021 NCCI NCCI Sequential procedures 50205 10022 NCCI NCCI Sequential procedures 50205 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50205 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50205 49002 BCBST OB-GYN procedure -- standard subset procedure rationale. 50205 49010 NCCI 50205 49255 BCBST 50205 51701 NCCI Standards of medical/surgical practice 50205 51702 NCCI Standards of medical/surgical practice 50205 51703 NCCI Standards of medical/surgical practice 50205 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 64416 NCCI NCCI Refer to Specific Guidelines 50205 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50205 90775 NCCI Standards of medical/surgical practice 50205 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50220 32422 NCCI CPT ''separate procedure'' definition 50220 32551 NCCI CPT ''separate procedure'' definition 50220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 13 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50220 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50220 49002 NCCI NCCI Standards of medical / surgical practice 50220 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50220 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50220 50205 NCCI NCCI Most extensive procedures 50220 50250 NCCI Most extensive procedure 50220 50280 NCCI NCCI Most extensive procedures 50220 50290 NCCI NCCI Most extensive procedures 50220 50541 NCCI NCCI Most extensive procedures 50220 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50220 50543 NCCI Most extensive procedures 50220 50544 NCCI NCCI Most extensive procedures 50220 50546 NCCI NCCI Most extensive procedures 50220 50548 NCCI NCCI Most extensive procedures 50220 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50220 51701 NCCI Standards of medical/surgical practice 50220 51702 NCCI Standards of medical/surgical practice 50220 51703 NCCI Standards of medical/surgical practice 50220 52005 NCCI NCCI Most extensive procedures 50220 60540 NCCI Inappropriate Interpretation of CPT Code Definition 50220 60545 NCCI Inappropriate Interpretation of CPT Code Definition 50220 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 64416 NCCI NCCI Refer to Specific Guidelines 50220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50220 90775 NCCI Standards of medical/surgical practice 50220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50225 20650 NCCI NCCI HCPCS/CPT separate procedure definition 50225 32422 NCCI CPT ''separate procedure'' definition 50225 32551 NCCI CPT ''separate procedure'' definition 50225 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 14 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50225 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50225 49002 NCCI NCCI Standards of medical / surgical practice 50225 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50225 49203 NCCI CPT manual and CMS coding manual instructions 50225 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50225 50205 NCCI NCCI Most extensive procedures 50225 50220 NCCI NCCI HCPCS/CPT procedure code definition 50225 50250 NCCI Most extensive procedure 50225 50280 NCCI NCCI Most extensive procedures 50225 50290 NCCI NCCI Most extensive procedures 50225 50541 NCCI NCCI Most extensive procedures 50225 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50225 50543 NCCI Most extensive procedures 50225 50544 NCCI NCCI Most extensive procedures 50225 50545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 50546 NCCI NCCI Most extensive procedures 50225 50548 NCCI NCCI Most extensive procedures 50225 50650 NCCI HCPCS/CPT "separate procedure" definition 50225 51701 NCCI Standards of medical/surgical practice 50225 51702 NCCI Standards of medical/surgical practice 50225 51703 NCCI Standards of medical/surgical practice 50225 60540 NCCI Inappropriate Interpretation of CPT Code Definition 50225 60545 NCCI Inappropriate Interpretation of CPT Code Definition 50225 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50225 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 64416 NCCI NCCI Refer to Specific Guidelines 50225 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50225 90775 NCCI Standards of medical/surgical practice 50225 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50230 32422 NCCI CPT ''separate procedure'' definition 50230 32551 NCCI CPT ''separate procedure'' definition 50230 35761 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 15 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50230 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 38100 NCCI NCCI Standards of medical / surgical practice 50230 38562 NCCI 50230 38562 BCBST 50230 38564 NCCI 50230 38570 NCCI 50230 38765 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 38770 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 38780 NCCI 50230 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50230 49000 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 49002 BCBST OB-GYN procedure -- standard subset procedure rationale. 50230 49010 NCCI NCCI Refer to Specific Guidelines 50230 49010 NCCI NCCI Standards of medical / surgical practice 50230 49010 NCCI NCCI Standards of medical / surgical practice 50230 49255 NCCI NCCI Standards of medical / surgical practice 50230 50080 NCCI NCCI Most extensive procedures 50230 50081 NCCI NCCI Most extensive procedures 50230 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50230 50205 NCCI NCCI Most extensive procedures 50230 50220 NCCI NCCI HCPCS/CPT procedure code definition 50230 50240 BCBST 50230 50250 NCCI Most extensive procedure 50230 50280 NCCI NCCI Most extensive procedures 50230 50290 NCCI NCCI Most extensive procedures 50230 50526 NCCI NCCI Standards of medical / surgical practice 50230 50541 NCCI NCCI Most extensive procedures 50230 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50230 50543 NCCI Most extensive procedures 50230 50544 NCCI NCCI Most extensive procedures 50230 50546 NCCI NCCI Most extensive procedures 50230 50548 NCCI NCCI Most extensive procedures 50230 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50230 51701 NCCI Standards of medical/surgical practice 50230 51702 NCCI Standards of medical/surgical practice 50230 51703 NCCI Standards of medical/surgical practice HCPCS/CPT coding manual instruction/guideline OB-GYN procedure -- standard subset procedure rationale. HCPCS/CPT coding manual instruction/guideline NCCI Most extensive procedures NCCI Standards of medical / surgical practice OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 16 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50230 52281 NCCI NCCI Most extensive procedures 50230 52332 NCCI NCCI Most extensive procedures 50230 60540 NCCI Standards of Medical/Surgical Practice 50230 60545 NCCI Standards of Medical/Surgical Practice 50230 60650 NCCI Most Extensive Procedures 50230 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 64416 NCCI NCCI Refer to Specific Guidelines 50230 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50230 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50230 90775 NCCI Standards of medical/surgical practice 50230 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50234 32422 NCCI CPT ''separate procedure'' definition 50234 32551 NCCI CPT ''separate procedure'' definition 50234 37202 NCCI 50234 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50234 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50234 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50234 49000 NCCI 50234 49002 BCBST 50234 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50234 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50234 50220 BCBST OB-GYN procedure -- standard subset procedure rationale. 50234 50230 BCBST OB-GYN procedure -- standard subset procedure rationale. 50234 50236 NCCI 50234 50240 BCBST 50234 50250 NCCI Most extensive procedure 50234 50280 NCCI NCCI Most extensive procedures 50234 50290 NCCI NCCI Most extensive procedures 50234 50500 NCCI NCCI Standards of medical / surgical practice 50234 50541 NCCI NCCI Most extensive procedures 50234 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50234 50543 NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Mutually exclusive procedures OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 17 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50234 50544 NCCI 50234 50545 BCBST 50234 50546 NCCI NCCI Most extensive procedures 50234 50548 NCCI NCCI Most extensive procedures 50234 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50234 50660 NCCI NCCI HCPCS/CPT procedure code definition 50234 51701 NCCI Standards of medical/surgical practice 50234 51702 NCCI Standards of medical/surgical practice 50234 51703 NCCI Standards of medical/surgical practice 50234 52240 NCCI NCCI Standards of medical / surgical practice 50234 60540 NCCI CPT Separate Procedure Definition 50234 60545 NCCI CPT Separate Procedure Definition 50234 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50234 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 64416 NCCI NCCI Refer to Specific Guidelines 50234 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50234 90775 NCCI Standards of medical/surgical practice 50234 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50236 32422 NCCI CPT ''separate procedure'' definition 50236 32551 NCCI CPT ''separate procedure'' definition 50236 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50236 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50236 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50236 49000 NCCI 50236 49002 BCBST 50236 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50236 49203 NCCI CPT manual and CMS coding manual instructions 50236 49204 NCCI CPT manual and CMS coding manual instructions 50236 50100 NCCI 50236 50220 BCBST NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code / This edit is considered a part of the more extensive listed procedure. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 18 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50236 50230 BCBST OB-GYN procedure -- standard subset procedure rationale. 50236 50240 BCBST OB-GYN procedure -- standard subset procedure rationale. 50236 50250 NCCI Most extensive procedure 50236 50280 NCCI NCCI Most extensive procedures 50236 50290 NCCI NCCI Most extensive procedures 50236 50500 NCCI NCCI Standards of medical / surgical practice 50236 50541 NCCI NCCI Most extensive procedures 50236 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50236 50543 NCCI Most extensive procedures 50236 50544 NCCI 50236 50545 BCBST 50236 50546 NCCI NCCI Most extensive procedures 50236 50548 NCCI NCCI Most extensive procedures 50236 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50236 50660 NCCI NCCI HCPCS/CPT procedure code definition 50236 51701 NCCI Standards of medical/surgical practice 50236 51702 NCCI Standards of medical/surgical practice 50236 51703 NCCI Standards of medical/surgical practice 50236 52240 NCCI NCCI Standards of medical / surgical practice 50236 60540 NCCI CPT Separate Procedure Definition 50236 60545 NCCI CPT Separate Procedure Definition 50236 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50236 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 64416 NCCI NCCI Refer to Specific Guidelines 50236 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50236 90775 NCCI Standards of medical/surgical practice 50236 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50240 32422 NCCI CPT ''separate procedure'' definition 50240 32551 NCCI CPT ''separate procedure'' definition 50240 35840 NCCI NCCI Standards of medical / surgical practice 50240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 44680 BCBST NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code / This edit is considered a part of the more extensive listed procedure. OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 19 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50240 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50240 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50240 49000 NCCI 50240 49002 BCBST 50240 49010 NCCI 50240 49255 BCBST 50240 50100 NCCI 50240 50220 BCBST 50240 50250 NCCI Most extensive procedure 50240 50280 NCCI NCCI Most extensive procedures 50240 50290 NCCI NCCI Most extensive procedures 50240 50500 NCCI NCCI Standards of medical / surgical practice 50240 50541 NCCI NCCI Most extensive procedures 50240 50542 NCCI HCPCS/CPT coding manual instruction / guideline 50240 50543 NCCI HCPCS/CPT coding manual instruction / guideline 50240 50544 NCCI NCCI Standards of medical / surgical practice 50240 51701 NCCI Standards of medical/surgical practice 50240 51702 NCCI Standards of medical/surgical practice 50240 51703 NCCI Standards of medical/surgical practice 50240 60540 NCCI CPT Separate Procedure Definition 50240 60545 NCCI CPT Separate Procedure Definition 50240 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 64416 NCCI NCCI Refer to Specific Guidelines 50240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50240 90775 NCCI Standards of medical/surgical practice 50240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50250 36000 NCCI Standards of medical/surgical practice 50250 36410 NCCI Standards of medical/surgical practice 50250 37202 NCCI Misuse of column 2 code with column 1 code 50250 43752 NCCI Misuse of column 2 code with column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 20 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50250 44820 NCCI HCPCS/CPT separate proceure definition 50250 44850 NCCI HCPCS/CPT separate proceure definition 50250 44950 NCCI HCPCS/CPT coding manual instruction/guideline 50250 49000 NCCI HCPCS/CPT separate proceure definition 50250 49002 NCCI Standards of medical/surgical practice 50250 49010 NCCI HCPCS/CPT separate proceure definition 50250 49203 NCCI Most extensive procedure 50250 50040 NCCI Most extensive procedure 50250 50045 NCCI Most extensive procedure 50250 50100 NCCI HCPCS/CPT separate proceure definition 50250 50500 NCCI Standards of medical/surgical practice 50250 50541 NCCI Most extensive procedure 50250 50542 NCCI Most extensive procedure 50250 50544 NCCI Most extensive procedure 50250 50592 NCCI Mutually Exclusive 50250 50593 NCCI Mutually exclusive procedures 50250 50715 NCCI Misuse of column 2 code with column 1 code 50250 51701 NCCI Standards of medical/surgical practice 50250 51702 NCCI Standards of medical/surgical practice 50250 51703 NCCI Standards of medical/surgical practice 50250 62318 NCCI Misuse of column 2 code with column 1 code 50250 62319 NCCI Misuse of column 2 code with column 1 code 50250 64415 NCCI Misuse of column 2 code with column 1 code 50250 64416 NCCI Misuse of column 2 code with column 1 code 50250 64417 NCCI Misuse of column 2 code with column 1 code 50250 64450 NCCI Misuse of column 2 code with column 1 code 50250 64470 NCCI Misuse of column 2 code with column 1 code 50250 64475 NCCI Misuse of column 2 code with column 1 code 50250 69990 NCCI Misuse of column 2 code with column 1 code 50250 76940 NCCI HCPCS/CPT procedure code definition 50250 76942 NCCI HCPCS/CPT procedure code definition 50250 76998 NCCI HCPCS/CPT procedure code definition 50250 90775 NCCI Standards of medical/surgical practice 50280 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50280 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50280 49002 NCCI NCCI Standards of medical / surgical practice 50280 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50280 50040 NCCI NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 21 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50280 50045 NCCI NCCI Most extensive procedures 50280 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50280 50500 NCCI NCCI Standards of medical / surgical practice 50280 50541 NCCI NCCI Most extensive procedures 50280 50544 NCCI NCCI Most extensive procedures 50280 51701 NCCI Standards of medical/surgical practice 50280 51702 NCCI Standards of medical/surgical practice 50280 51703 NCCI Standards of medical/surgical practice 50280 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 64416 NCCI NCCI Refer to Specific Guidelines 50280 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50280 90775 NCCI Standards of medical/surgical practice 50280 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50290 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50290 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50290 49002 NCCI NCCI Standards of medical / surgical practice 50290 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50290 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50290 50544 NCCI NCCI Most extensive procedures 50290 51701 NCCI Standards of medical/surgical practice 50290 51702 NCCI Standards of medical/surgical practice 50290 51703 NCCI Standards of medical/surgical practice 50290 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 64416 NCCI NCCI Refer to Specific Guidelines 50290 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50290 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 22 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50290 90775 NCCI Standards of medical/surgical practice 50290 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50300 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50300 49002 NCCI NCCI Standards of medical / surgical practice 50300 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50300 50220 NCCI Misuse of Column 2 code with Column 1 code 50300 50225 NCCI Misuse of Column 2 code with Column 1 code 50300 50230 NCCI Misuse of Column 2 code with Column 1 code 50300 50234 NCCI Misuse of Column 2 code with Column 1 code 50300 50236 NCCI Misuse of Column 2 code with Column 1 code 50300 50240 NCCI 50300 50300 BCBST 50300 50541 NCCI NCCI Most extensive procedures 50300 50542 NCCI Misuse of Column 2 code with Column 1 code 50300 50543 NCCI Misuse of Column 2 code with Column 1 code 50300 50544 NCCI NCCI Most extensive procedures 50300 50545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 50546 NCCI NCCI Most extensive procedures 50300 50548 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 64416 NCCI NCCI Refer to Specific Guidelines 50300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50320 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50320 49002 NCCI NCCI Standards of medical / surgical practice 50320 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50320 50220 NCCI Misuse of Column 2 code with Column 1 code 50320 50225 NCCI Misuse of Column 2 code with Column 1 code Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 23 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50320 50230 NCCI Misuse of Column 2 code with Column 1 code 50320 50234 NCCI Misuse of Column 2 code with Column 1 code 50320 50236 NCCI Misuse of Column 2 code with Column 1 code 50320 50240 NCCI Misuse of Column 2 code with Column 1 code 50320 50541 NCCI NCCI Most extensive procedures 50320 50542 NCCI Misuse of Column 2 code with Column 1 code 50320 50543 NCCI Misuse of Column 2 code with Column 1 code 50320 50544 NCCI NCCI Most extensive procedures 50320 50545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 50546 NCCI NCCI Most extensive procedures 50320 50547 NCCI NCCI Sequential procedures 50320 50548 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50320 51701 NCCI Standards of medical/surgical practice 50320 51702 NCCI Standards of medical/surgical practice 50320 51703 NCCI Standards of medical/surgical practice 50320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 64416 NCCI NCCI Refer to Specific Guidelines 50320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50320 90775 NCCI Standards of medical/surgical practice 50320 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50323 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50325 50323 NCCI Mutually exclusive procedure 50325 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50327 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50328 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50329 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50340 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50340 49000 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 24 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50340 49002 NCCI NCCI Standards of medical / surgical practice 50340 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50340 50220 NCCI Misuse of Column 2 code with Column 1 code 50340 50225 NCCI Misuse of Column 2 code with Column 1 code 50340 50230 NCCI Misuse of Column 2 code with Column 1 code 50340 50234 NCCI Misuse of Column 2 code with Column 1 code 50340 50236 NCCI Misuse of Column 2 code with Column 1 code 50340 50240 NCCI Misuse of Column 2 code with Column 1 code 50340 50541 NCCI NCCI Most extensive procedures 50340 50542 NCCI Misuse of Column 2 code with Column 1 code 50340 50543 NCCI Misuse of Column 2 code with Column 1 code 50340 50544 NCCI NCCI Most extensive procedures 50340 50545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 50546 NCCI NCCI Most extensive procedures 50340 50548 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50340 51701 NCCI Standards of medical/surgical practice 50340 51702 NCCI Standards of medical/surgical practice 50340 51703 NCCI Standards of medical/surgical practice 50340 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 64416 NCCI NCCI Refer to Specific Guidelines 50340 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50340 90775 NCCI Standards of medical/surgical practice 50340 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50360 35221 NCCI NCCI Standards of medical / surgical practice 50360 35840 NCCI NCCI Standards of medical / surgical practice 50360 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50360 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50360 49002 NCCI NCCI Standards of medical / surgical practice 50360 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50360 49421 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 25 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50360 50200 NCCI NCCI Standards of medical / surgical practice 50360 50220 NCCI HCPCS/CPT procedure code definition 50360 50225 NCCI HCPCS/CPT procedure code definition 50360 50230 NCCI HCPCS/CPT procedure code definition 50360 50234 NCCI HCPCS/CPT procedure code definition 50360 50236 NCCI HCPCS/CPT procedure code definition 50360 50240 NCCI HCPCS/CPT procedure code definition 50360 50360 BCBST 50360 50400 NCCI NCCI Standards of medical / surgical practice 50360 50780 NCCI NCCI Standards of medical / surgical practice 50360 51701 NCCI Standards of medical/surgical practice 50360 51702 NCCI Standards of medical/surgical practice 50360 51703 NCCI Standards of medical/surgical practice 50360 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 64416 NCCI NCCI Refer to Specific Guidelines 50360 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50360 90775 NCCI Standards of medical/surgical practice 50360 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50360 S2065 BCBST This edited HCPCS code represents essentially the same or very similar service as the listed CPT code. In general, one or the other, but not both, may be reported. 50365 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50365 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50365 49002 NCCI NCCI Standards of medical / surgical practice 50365 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50365 50220 NCCI HCPCS/CPT procedure code definition 50365 50225 NCCI HCPCS/CPT procedure code definition 50365 50230 NCCI HCPCS/CPT procedure code definition 50365 50234 NCCI HCPCS/CPT procedure code definition 50365 50236 NCCI HCPCS/CPT procedure code definition 50365 50240 NCCI HCPCS/CPT procedure code definition 50365 50340 NCCI NCCI HCPCS/CPT separate procedure definition 50365 50541 NCCI NCCI Most extensive procedures Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 26 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50365 50542 NCCI Misuse of Column 2 code with Column 1 code 50365 50543 NCCI Misuse of Column 2 code with Column 1 code 50365 50544 NCCI NCCI Most extensive procedures 50365 50545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 50546 NCCI NCCI Most extensive procedures 50365 50548 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50365 50780 NCCI Standards of medical / surgical practice 50365 51701 NCCI Standards of medical/surgical practice 50365 51702 NCCI Standards of medical/surgical practice 50365 51703 NCCI Standards of medical/surgical practice 50365 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 64416 NCCI NCCI Refer to Specific Guidelines 50365 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50365 90775 NCCI Standards of medical/surgical practice 50365 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50365 S2065 BCBST This edited HCPCS code represents essentially the same or very similar service as the listed CPT code. In general, one or the other, but not both, may be reported. 50370 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50370 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50370 49002 NCCI NCCI Standards of medical / surgical practice 50370 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50370 50220 NCCI Misuse of Column 2 code with Column 1 code 50370 50225 NCCI Misuse of Column 2 code with Column 1 code 50370 50234 NCCI Misuse of Column 2 code with Column 1 code 50370 50236 NCCI Misuse of Column 2 code with Column 1 code 50370 50240 NCCI Misuse of Column 2 code with Column 1 code 50370 50340 NCCI NCCI HCPCS/CPT separate procedure definition 50370 50370 BCBST 50370 50541 NCCI NCCI Most extensive procedures 50370 50542 NCCI Misuse of Column 2 code with Column 1 code 50370 50543 NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 27 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50370 50544 NCCI NCCI Most extensive procedures 50370 50546 NCCI NCCI Most extensive procedures 50370 50548 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 51701 NCCI Standards of medical/surgical practice 50370 51702 NCCI Standards of medical/surgical practice 50370 51703 NCCI Standards of medical/surgical practice 50370 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 64416 NCCI NCCI Refer to Specific Guidelines 50370 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50370 90775 NCCI Standards of medical/surgical practice 50370 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50380 35840 NCCI NCCI Standards of medical / surgical practice 50380 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50380 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50380 49002 NCCI NCCI Standards of medical / surgical practice 50380 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50380 50340 NCCI 50380 50380 BCBST 50380 50544 NCCI NCCI Most extensive procedures 50380 50780 NCCI Standards of medical / surgical practice 50380 51701 NCCI Standards of medical/surgical practice 50380 51702 NCCI Standards of medical/surgical practice 50380 51703 NCCI Standards of medical/surgical practice 50380 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 64416 NCCI NCCI Refer to Specific Guidelines 50380 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 28 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50380 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50380 90775 NCCI Standards of medical/surgical practice 50380 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50382 36000 NCCI Standards of medical/surgical practice 50382 36410 NCCI Standards of medical/surgical practice 50382 37202 NCCI Misuse of column 2 code with column 1 code 50382 43752 NCCI Misuse of column 2 code with column 1 code 50382 50384 NCCI HCPCS/CPT procedure code definition 50382 50387 NCCI Mutually Exclusive 50382 50390 NCCI Most extensive procedure 50382 50392 NCCI Standards of medical/surgical practice 50382 50393 NCCI Standards of medical/surgical practice 50382 50394 NCCI Misuse of column 2 code with column 1 code 50382 50395 NCCI HCPCS/CPT coding manual instruction/guideline 50382 50688 NCCI Misuse of column 2 code with column 1 code 50382 51701 NCCI Standards of medical/surgical practice 50382 51702 NCCI Standards of medical/surgical practice 50382 51703 NCCI Standards of medical/surgical practice 50382 52332 NCCI Misuse of column 2 code with column 1 code 50382 62318 NCCI Misuse of column 2 code with column 1 code 50382 62319 NCCI Misuse of column 2 code with column 1 code 50382 64415 NCCI Misuse of column 2 code with column 1 code 50382 64416 NCCI Misuse of column 2 code with column 1 code 50382 64417 NCCI Misuse of column 2 code with column 1 code 50382 64450 NCCI Misuse of column 2 code with column 1 code 50382 64470 NCCI Misuse of column 2 code with column 1 code 50382 64475 NCCI Misuse of column 2 code with column 1 code 50382 69990 NCCI Misuse of column 2 code with column 1 code 50382 74475 NCCI Misuse of column 2 code with column 1 code 50382 74480 NCCI Misuse of column 2 code with column 1 code 50382 76000 NCCI HCPCS/CPT procedure code definition 50382 76001 NCCI HCPCS/CPT procedure code definition 50382 76942 NCCI HCPCS/CPT procedure code definition 50382 76998 NCCI HCPCS/CPT procedure code definition 50382 77002 NCCI HCPCS/CPT procedure code definition 50382 90775 NCCI Standards of medical/surgical practice 50382 93000 NCCI Standards of medical/surgical practice 50382 93005 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 29 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50382 93010 NCCI Standards of medical/surgical practice 50382 93040 NCCI Standards of medical/surgical practice 50382 93041 NCCI Standards of medical/surgical practice 50382 93042 NCCI Standards of medical/surgical practice 50382 94770 NCCI Standards of medical/surgical practice 50382 99143 NCCI HCPCS/CPT coding manual instruction/guideline 50382 99144 NCCI HCPCS/CPT coding manual instruction/guideline 50382 99145 NCCI HCPCS/CPT coding manual instruction/guideline 50382 99148 NCCI Standard preparation/monitoring services for anesthesia 50382 99149 NCCI Standard preparation/monitoring services for anesthesia 50382 99150 NCCI Standard preparation/monitoring services for anesthesia 50384 36000 NCCI Standards of medical/surgical practice 50384 36410 NCCI Standards of medical/surgical practice 50384 37202 NCCI Misuse of column 2 code with column 1 code 50384 43752 NCCI Misuse of column 2 code with column 1 code 50384 50387 NCCI Mutually Exclusive 50384 50390 NCCI Standards of medical/surgical practice 50384 50392 NCCI Standards of medical/surgical practice 50384 50393 NCCI Misuse of column 2 code with column 1 code 50384 50394 NCCI Misuse of column 2 code with column 1 code 50384 50395 NCCI HCPCS/CPT coding manual instruction/guideline 50384 50688 NCCI Misuse of column 2 code with column 1 code 50384 51701 NCCI Standards of medical/surgical practice 50384 51702 NCCI Standards of medical/surgical practice 50384 51703 NCCI Standards of medical/surgical practice 50384 52332 NCCI Misuse of column 2 code with column 1 code 50384 62318 NCCI Misuse of column 2 code with column 1 code 50384 62319 NCCI Misuse of column 2 code with column 1 code 50384 64415 NCCI Misuse of column 2 code with column 1 code 50384 64416 NCCI Misuse of column 2 code with column 1 code 50384 64417 NCCI Misuse of column 2 code with column 1 code 50384 64450 NCCI Misuse of column 2 code with column 1 code 50384 64470 NCCI Misuse of column 2 code with column 1 code 50384 64475 NCCI Misuse of column 2 code with column 1 code 50384 69990 NCCI Misuse of column 2 code with column 1 code 50384 74475 NCCI Misuse of column 2 code with column 1 code 50384 74480 NCCI Misuse of column 2 code with column 1 code 50384 76000 NCCI HCPCS/CPT procedure code definition 50384 76001 NCCI HCPCS/CPT procedure code definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 30 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50384 76942 NCCI HCPCS/CPT procedure code definition 50384 76998 NCCI HCPCS/CPT procedure code definition 50384 77002 NCCI HCPCS/CPT procedure code definition 50384 90775 NCCI Standards of medical/surgical practice 50384 93000 NCCI Standards of medical/surgical practice 50384 93005 NCCI Standards of medical/surgical practice 50384 93010 NCCI Standards of medical/surgical practice 50384 93040 NCCI Standards of medical/surgical practice 50384 93041 NCCI Standards of medical/surgical practice 50384 93042 NCCI Standards of medical/surgical practice 50384 94770 NCCI Standards of medical/surgical practice 50384 99143 NCCI HCPCS/CPT coding manual instruction/guideline 50384 99144 NCCI HCPCS/CPT coding manual instruction/guideline 50384 99145 NCCI HCPCS/CPT coding manual instruction/guideline 50384 99148 NCCI Standard preparation/monitoring services for anesthesia 50384 99149 NCCI Standard preparation/monitoring services for anesthesia 50384 99150 NCCI Standard preparation/monitoring services for anesthesia 50385 36000 NCCI Standards of medical/surgical practice 50385 36410 NCCI Standards of medical/surgical practice 50385 37202 NCCI Misuse of column 2 code with column 1 code 50385 50386 NCCI HCPCS/CPT procedure code definition 50385 62318 NCCI Misuse of column 2 code with column 1 code 50385 62319 NCCI Misuse of column 2 code with column 1 code 50385 64415 NCCI Misuse of column 2 code with column 1 code 50385 64416 NCCI Misuse of column 2 code with column 1 code 50385 64417 NCCI Misuse of column 2 code with column 1 code 50385 64450 NCCI Misuse of column 2 code with column 1 code 50385 64470 NCCI Misuse of column 2 code with column 1 code 50385 64475 NCCI Misuse of column 2 code with column 1 code 50385 69990 NCCI Misuse of column 2 code with column 1 code 50385 76000 NCCI HCPCS/CPT procedure code definition 50385 76001 NCCI HCPCS/CPT procedure code definition 50385 76942 NCCI HCPCS/CPT procedure code definition 50385 76998 NCCI HCPCS/CPT procedure code definition 50385 77002 NCCI HCPCS/CPT procedure code definition 50385 90775 NCCI Standards of medical/surgical practice 50385 93000 NCCI Standards of medical/surgical practice 50385 93005 NCCI Standards of medical/surgical practice 50385 93010 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 31 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50385 93040 NCCI Standards of medical/surgical practice 50385 93041 NCCI Standards of medical/surgical practice 50385 93042 NCCI Standards of medical/surgical practice 50385 94770 NCCI Standards of medical/surgical practice 50385 99143 NCCI CPT manual and CMS coding manual instructions 50385 99144 NCCI CPT manual and CMS coding manual instructions 50385 99145 NCCI CPT manual and CMS coding manual instructions 50385 99148 NCCI Standard preparation/monitoring services for anesthesia 50385 99149 NCCI Standard preparation/monitoring services for anesthesia 50385 99150 NCCI Standard preparation/monitoring services for anesthesia 50386 36000 NCCI Standards of medical/surgical practice 50386 36410 NCCI Standards of medical/surgical practice 50386 37202 NCCI Misuse of column 2 code with column 1 code 50386 62318 NCCI Misuse of column 2 code with column 1 code 50386 62319 NCCI Misuse of column 2 code with column 1 code 50386 64415 NCCI Misuse of column 2 code with column 1 code 50386 64416 NCCI Misuse of column 2 code with column 1 code 50386 64417 NCCI Misuse of column 2 code with column 1 code 50386 64450 NCCI Misuse of column 2 code with column 1 code 50386 64470 NCCI Misuse of column 2 code with column 1 code 50386 64475 NCCI Misuse of column 2 code with column 1 code 50386 69990 NCCI Misuse of column 2 code with column 1 code 50386 76000 NCCI HCPCS/CPT procedure code definition 50386 76001 NCCI HCPCS/CPT procedure code definition 50386 76942 NCCI HCPCS/CPT procedure code definition 50386 76998 NCCI HCPCS/CPT procedure code definition 50386 77002 NCCI HCPCS/CPT procedure code definition 50386 90775 NCCI Standards of medical/surgical practice 50386 93000 NCCI Standards of medical/surgical practice 50386 93005 NCCI Standards of medical/surgical practice 50386 93010 NCCI Standards of medical/surgical practice 50386 93040 NCCI Standards of medical/surgical practice 50386 93041 NCCI Standards of medical/surgical practice 50386 93042 NCCI Standards of medical/surgical practice 50386 94770 NCCI Standards of medical/surgical practice 50386 99143 NCCI CPT manual and CMS coding manual instructions 50386 99144 NCCI CPT manual and CMS coding manual instructions 50386 99145 NCCI CPT manual and CMS coding manual instructions 50386 99148 NCCI Standard preparation/monitoring services for anesthesia CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 32 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50386 99149 NCCI Standard preparation/monitoring services for anesthesia 50386 99150 NCCI Standard preparation/monitoring services for anesthesia 50387 36000 NCCI Standards of medical/surgical practice 50387 36410 NCCI Standards of medical/surgical practice 50387 37202 NCCI Misuse of column 2 code with column 1 code 50387 43752 NCCI Misuse of column 2 code with column 1 code 50387 50392 NCCI Misuse of column 2 code with column 1 code 50387 50393 NCCI Misuse of column 2 code with column 1 code 50387 50394 NCCI Misuse of column 2 code with column 1 code 50387 50395 NCCI Misuse of column 2 code with column 1 code 50387 50398 NCCI Mutually Exclusive 50387 50688 NCCI Mutually Exclusive 50387 51701 NCCI Standards of medical/surgical practice 50387 51702 NCCI Standards of medical/surgical practice 50387 51703 NCCI Standards of medical/surgical practice 50387 62318 NCCI Misuse of column 2 code with column 1 code 50387 62319 NCCI Misuse of column 2 code with column 1 code 50387 64415 NCCI Misuse of column 2 code with column 1 code 50387 64416 NCCI Misuse of column 2 code with column 1 code 50387 64417 NCCI Misuse of column 2 code with column 1 code 50387 64450 NCCI Misuse of column 2 code with column 1 code 50387 64470 NCCI Misuse of column 2 code with column 1 code 50387 64475 NCCI Misuse of column 2 code with column 1 code 50387 69990 NCCI Misuse of column 2 code with column 1 code 50387 74475 NCCI Misuse of column 2 code with column 1 code 50387 74480 NCCI Misuse of column 2 code with column 1 code 50387 74485 NCCI Misuse of column 2 code with column 1 code 50387 76000 NCCI HCPCS/CPT procedure code definition 50387 76001 NCCI HCPCS/CPT procedure code definition 50387 77002 NCCI HCPCS/CPT procedure code definition 50387 90775 NCCI Standards of medical/surgical practice 50387 93000 NCCI Standards of medical/surgical practice 50387 93005 NCCI Standards of medical/surgical practice 50387 93010 NCCI Standards of medical/surgical practice 50387 93040 NCCI Standards of medical/surgical practice 50387 93041 NCCI Standards of medical/surgical practice 50387 93042 NCCI Standards of medical/surgical practice 50387 94770 NCCI Standards of medical/surgical practice 50387 99143 NCCI HCPCS/CPT coding manual instruction/guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 33 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50387 99144 NCCI HCPCS/CPT coding manual instruction/guideline 50387 99145 NCCI HCPCS/CPT coding manual instruction/guideline 50387 99148 NCCI Standard preparation/monitoring services for anesthesia 50387 99149 NCCI Standard preparation/monitoring services for anesthesia 50387 99150 NCCI Standard preparation/monitoring services for anesthesia 50389 36000 NCCI Standards of medical/surgical practice 50389 36410 NCCI Standards of medical/surgical practice 50389 37202 NCCI Misuse of column 2 code with column 1 code 50389 43752 NCCI Misuse of column 2 code with column 1 code 50389 50393 NCCI Misuse of column 2 code with column 1 code 50389 50394 NCCI Misuse of column 2 code with column 1 code 50389 51701 NCCI Standards of medical/surgical practice 50389 51702 NCCI Standards of medical/surgical practice 50389 51703 NCCI Standards of medical/surgical practice 50389 62318 NCCI Misuse of column 2 code with column 1 code 50389 62319 NCCI Misuse of column 2 code with column 1 code 50389 64415 NCCI Misuse of column 2 code with column 1 code 50389 64416 NCCI Misuse of column 2 code with column 1 code 50389 64417 NCCI Misuse of column 2 code with column 1 code 50389 64450 NCCI Misuse of column 2 code with column 1 code 50389 64470 NCCI Misuse of column 2 code with column 1 code 50389 64475 NCCI Misuse of column 2 code with column 1 code 50389 69990 NCCI Misuse of column 2 code with column 1 code 50389 76000 NCCI HCPCS/CPT procedure code definition 50389 76001 NCCI HCPCS/CPT procedure code definition 50389 77002 NCCI Misuse of column 2 code with column 1 code 50389 90775 NCCI Standards of medical/surgical practice 50390 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 51701 NCCI Standards of medical/surgical practice 50390 51702 NCCI Standards of medical/surgical practice 50390 51703 NCCI Standards of medical/surgical practice 50390 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 64416 NCCI NCCI Refer to Specific Guidelines 50390 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 34 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50390 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50390 90775 NCCI Standards of medical/surgical practice 50390 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50391 00860 NCCI Anesthesia included in surgical procedures 50391 00862 NCCI Anesthesia included in surgical procedures 50391 36000 NCCI Standards of medical / surgical practice 50391 36410 NCCI Standards of medical / surgical practice 50391 50390 NCCI Misuse of column 2 code with column 1 code 50391 50392 NCCI Misuse of column 2 code with column 1 code 50391 50393 NCCI Misuse of column 2 code with column 1 code 50391 51701 NCCI Standards of medical/surgical practice 50391 51702 NCCI Standards of medical/surgical practice 50391 51703 NCCI Standards of medical/surgical practice 50391 64450 NCCI Misuse of Column 2 code with Column 1 code 50391 90775 NCCI Standards of medical/surgical practice 50391 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50392 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 50390 NCCI NCCI Most extensive procedures 50392 50398 NCCI NCCI Standards of medical / surgical practice 50392 51701 NCCI Standards of medical/surgical practice 50392 51702 NCCI Standards of medical/surgical practice 50392 51703 NCCI Standards of medical/surgical practice 50392 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 64416 NCCI NCCI Refer to Specific Guidelines 50392 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50392 77002 NCCI HCPCS/CPT coding manual instruction/guideline 50392 90775 NCCI Standards of medical/surgical practice 50392 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50393 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 49424 NCCI NCCI HCPCS/CPT separate procedure definition 50393 50392 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 35 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50393 50398 NCCI NCCI Standards of medical / surgical practice 50393 51701 NCCI Standards of medical/surgical practice 50393 51702 NCCI Standards of medical/surgical practice 50393 51703 NCCI Standards of medical/surgical practice 50393 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 64416 NCCI NCCI Refer to Specific Guidelines 50393 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50393 90775 NCCI Standards of medical/surgical practice 50393 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50394 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 51701 NCCI Standards of medical/surgical practice 50394 51702 NCCI Standards of medical/surgical practice 50394 51703 NCCI Standards of medical/surgical practice 50394 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 64416 NCCI NCCI Refer to Specific Guidelines 50394 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50394 77002 NCCI HCPCS/CPT coding manual instruction/guideline 50394 90775 NCCI Standards of medical/surgical practice 50394 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50395 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 50392 NCCI NCCI Refer to Specific Guidelines 50395 50398 NCCI NCCI Standards of medical / surgical practice 50395 51701 NCCI Standards of medical/surgical practice 50395 51702 NCCI Standards of medical/surgical practice 50395 51703 NCCI Standards of medical/surgical practice 50395 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 36 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50395 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 64416 NCCI NCCI Refer to Specific Guidelines 50395 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50395 76000 NCCI HCPCS/CPT coding manual instruction / guideline 50395 76001 NCCI HCPCS/CPT coding manual instruction / guideline 50395 77002 NCCI HCPCS/CPT coding manual instruction/guideline 50395 90775 NCCI Standards of medical/surgical practice 50395 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50396 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 51701 NCCI Standards of medical/surgical practice 50396 51702 NCCI Standards of medical/surgical practice 50396 51703 NCCI Standards of medical/surgical practice 50396 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 64416 NCCI NCCI Refer to Specific Guidelines 50396 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50396 77002 NCCI HCPCS/CPT coding manual instruction/guideline 50396 90775 NCCI Standards of medical/surgical practice 50396 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50398 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 49424 NCCI NCCI HCPCS/CPT separate procedure definition 50398 51701 NCCI Standards of medical/surgical practice 50398 51702 NCCI Standards of medical/surgical practice 50398 51703 NCCI Standards of medical/surgical practice 50398 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 64416 NCCI NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 37 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50398 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 76000 NCCI Misuse of Column 2 code with Column 1 code 50398 76942 NCCI NCCI Misuse of Column 2 code with Column 1 code 50398 77002 NCCI Misuse of column 2 code with column 1 code 50398 77012 NCCI Misuse of column 2 code with column 1 code 50398 77021 NCCI Misuse of column 2 code with column 1 code 50398 90775 NCCI Standards of medical/surgical practice 50398 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50400 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50400 49002 NCCI NCCI Standards of medical / surgical practice 50400 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50400 50544 NCCI NCCI Most extensive procedures 50400 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 51701 NCCI Standards of medical/surgical practice 50400 51702 NCCI Standards of medical/surgical practice 50400 51703 NCCI Standards of medical/surgical practice 50400 52005 NCCI NCCI Most extensive procedures 50400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 64416 NCCI NCCI Refer to Specific Guidelines 50400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50400 90775 NCCI Standards of medical/surgical practice 50400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50405 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50405 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50405 49002 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 38 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50405 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50405 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50405 50400 NCCI NCCI Most extensive procedures 50405 50544 NCCI NCCI Most extensive procedures 50405 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 51701 NCCI Standards of medical/surgical practice 50405 51702 NCCI Standards of medical/surgical practice 50405 51703 NCCI Standards of medical/surgical practice 50405 52005 NCCI NCCI Most extensive procedures 50405 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 64416 NCCI NCCI Refer to Specific Guidelines 50405 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50405 90775 NCCI Standards of medical/surgical practice 50405 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50500 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50500 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50500 49000 NCCI 50500 49002 BCBST 50500 49010 NCCI 50500 49255 BCBST 50500 51701 NCCI Standards of medical/surgical practice 50500 51702 NCCI Standards of medical/surgical practice 50500 51703 NCCI Standards of medical/surgical practice 50500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 64416 NCCI NCCI Refer to Specific Guidelines 50500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 39 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50500 90775 NCCI Standards of medical/surgical practice 50500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50520 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50520 49002 NCCI NCCI Standards of medical / surgical practice 50520 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50520 50544 NCCI NCCI Most extensive procedures 50520 51701 NCCI Standards of medical/surgical practice 50520 51702 NCCI Standards of medical/surgical practice 50520 51703 NCCI Standards of medical/surgical practice 50520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 64416 NCCI NCCI Refer to Specific Guidelines 50520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50520 90775 NCCI Standards of medical/surgical practice 50520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50525 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50525 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50525 49002 NCCI NCCI Standards of medical / surgical practice 50525 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50525 50520 NCCI NCCI Standards of medical / surgical practice 50525 50526 NCCI NCCI Mutually exclusive procedures 50525 51701 NCCI Standards of medical/surgical practice 50525 51702 NCCI Standards of medical/surgical practice 50525 51703 NCCI Standards of medical/surgical practice 50525 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 40 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50525 64416 NCCI NCCI Refer to Specific Guidelines 50525 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50525 90775 NCCI Standards of medical/surgical practice 50525 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50526 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50526 49002 NCCI NCCI Standards of medical / surgical practice 50526 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50526 51701 NCCI Standards of medical/surgical practice 50526 51702 NCCI Standards of medical/surgical practice 50526 51703 NCCI Standards of medical/surgical practice 50526 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 64416 NCCI NCCI Refer to Specific Guidelines 50526 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50526 90775 NCCI Standards of medical/surgical practice 50526 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50540 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50540 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50540 49002 NCCI NCCI Standards of medical / surgical practice 50540 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50540 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50540 50400 NCCI NCCI Standards of medical / surgical practice 50540 50405 NCCI NCCI Standards of medical / surgical practice 50540 50540 BCBST 50540 50544 NCCI NCCI HCPCS/CPT procedure code definition 50540 51701 NCCI Standards of medical/surgical practice 50540 51702 NCCI Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 41 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50540 51703 NCCI Standards of medical/surgical practice 50540 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 64416 NCCI NCCI Refer to Specific Guidelines 50540 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50540 90775 NCCI Standards of medical/surgical practice 50540 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50541 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 43653 NCCI CPT "separate procedure" definition 50541 44005 NCCI Misuse of column 2 code with column 1 code 50541 44180 NCCI HCPCS/CPT separate procedure definition 50541 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50541 50390 NCCI NCCI Most extensive procedures 50541 50592 NCCI Mutually Exclusive 50541 50593 NCCI Mutually exclusive procedures 50541 51701 NCCI Standards of medical/surgical practice 50541 51702 NCCI Standards of medical/surgical practice 50541 51703 NCCI Standards of medical/surgical practice 50541 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50541 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 64416 NCCI NCCI Refer to Specific Guidelines 50541 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50541 90775 NCCI Standards of medical/surgical practice 50541 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50542 12001 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12002 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 42 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50542 12004 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12005 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12006 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12007 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12031 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12032 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12034 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12035 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12036 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 12037 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 13100 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 13101 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 13102 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50542 36000 BCBST Edited code not allowed if used to report incidental needle introduction at the time of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 50542 37202 BCBST The edited code is a component of the listed code if used to report minor anesthesia or infusion services provided as part of the listed procedure or according to surgical package instructions. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code policy, which indicates that a provider should not report a CPT code out of the context for which it was intended. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure. 50542 38570 BCBST Edited code not allowed when used to report incidental removal of lymph node at the time of the definitive procedure. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justfy reimbursement. 50542 44005 NCCI 50542 44180 NCCI HCPCS/CPT separate procedure definition 50542 49203 NCCI Most extensive procedure 50542 49320 BCBST Misuse of column 2 code with column 1 code As per CPT guidelines, a surgical laparoscopy always includes a diagnostic laparoscopy. This diagnostic laparoscopy code is not allowed if used to report exploratory or diagnostic laparoscopic services performed in conjunction with the surgical laparoscopy. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 43 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50542 49321 BCBST Edited code not allowed when used to report submission of surgical specimens for pathology or incidental biopsy at the time of the definitive procedure. When an endoscopic or open procedure is performed and a biopsy is also performed, followed by excision, destruction or removal of the biopsied lesion, the biopsy is not separately reported. This code may be appropriate to reimburse if performed with unrelated procedures, and if it involved significant additional work to justify reimbursement. 50542 49322 BCBST Edited code not allowed when used to report incidental aspiration at the time of the definitive procedure. When a laparoscopic or open procedure is performed and an incidental aspiration is also performed in the course of the procedure, the aspiration should not be separately reported. This code may be appropriate to reimburse if performed for medically indicated purposes and if it involved significant additional work to justify reimbursement. 50542 50390 BCBST Edited code not allowed when used to report incidental aspiration at the time of the definitive procedure. When a laparoscopic or open procedure is performed and an incidental aspiration is also performed in the course of the procedure, the aspiration should not be separately reported. This code may be appropriate to reimburse if performed for medically indicated purposes and if it involved significant additional work to justify reimbursement. 50542 50541 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justify reimbursement. 50542 50592 NCCI Mutually Exclusive 50542 50593 NCCI Mutually exclusive procedures 50542 51701 NCCI Standards of medical/surgical practice 50542 51702 NCCI Standards of medical/surgical practice 50542 51703 NCCI Standards of medical/surgical practice 50542 58660 BCBST Generic services integral to standard of medical/surgical services include lysis of simple adhesions. This code may be appropriate to reimburse in unusual clinical circumstances if review indicates that extensive adhesions were present and that the lysis of adhesions required significant additional work to perform. 50542 58740 BCBST Generic services integral to standard of medical/surgical services include lysis of simple adhesions. This code may be appropriate to reimburse in unusual clinical circumstances if review indicates that extensive adhesions were present and that an open lysis of adhesions was performed involving significant additional work. 50542 62318 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 62319 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 44 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50542 64415 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 64417 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 64450 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 64470 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 64475 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50542 69990 BCBST Operating microscope typically not required in performing the listed procedure, or is considered a part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 50542 90775 NCCI Standards of medical/surgical practice 50542 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50543 12001 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12002 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12004 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12005 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 45 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50543 12006 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12007 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12031 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12032 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12034 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12035 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12036 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 12037 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 13100 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 13101 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 13102 BCBST This repair or closure code should not be used to report the closure of the wound or repair of tissues divided for initial surgical exposure. 50543 36000 BCBST Edited code not allowed if used to report incidental needle introduction at the time of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 50543 37202 BCBST The edited code is a component of the listed code if used to report minor anesthesia or infusion services provided as part of the listed procedure or according to surgical package instructions. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code policy, which indicates that a provider should not report a CPT code out of the context for which it was intended. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure. 50543 38570 BCBST Edited code not allowed when used to report incidental removal of lymph node at the time of the definitive procedure. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justfy reimbursement. 50543 44005 NCCI Misuse of column 2 code with column 1 code 50543 44180 NCCI HCPCS/CPT separate procedure definition 50543 49320 BCBST As per CPT guidelines, a surgical laparoscopy always includes a diagnostic laparoscopy. This diagnostic laparoscopy code is not allowed if used to report exploratory or diagnostic laparoscopic services performed in conjunction with the surgical laparoscopy. 50543 49321 BCBST Edited code not allowed when used to report submission of surgical specimens for pathology or incidental biopsy at the time of the definitive procedure. When an endoscopic or open procedure is performed and a biopsy is also performed, followed by excision, destruction or removal of the biopsied lesion, the biopsy is not separately reported. This code may be appropriate to reimburse if performed with unrelated procedures, and if it involved significant additional work to justify reimbursement. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 46 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50543 49322 BCBST Edited code not allowed when used to report incidental aspiration at the time of the definitive procedure. When a laparoscopic or open procedure is performed and an incidental aspiration is also performed in the course of the procedure, the aspiration should not be separately reported. This code may be appropriate to reimburse if performed for medically indicated purposes and if it involved significant additional work to justify reimbursement. 50543 50390 BCBST Edited code not allowed when used to report incidental aspiration at the time of the definitive procedure. When a laparoscopic or open procedure is performed and an incidental aspiration is also performed in the course of the procedure, the aspiration should not be separately reported. This code may be appropriate to reimburse if performed for medically indicated purposes and if it involved significant additional work to justify reimbursement. 50543 50541 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justify reimbursement. 50543 50542 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justify reimbursement. 50543 51701 NCCI Standards of medical/surgical practice 50543 51702 NCCI Standards of medical/surgical practice 50543 51703 NCCI Standards of medical/surgical practice 50543 58660 BCBST Generic services integral to standard of medical/surgical services include lysis of simple adhesions. This code may be appropriate to reimburse in unusual clinical circumstances if review indicates that extensive adhesions were present and that the lysis of adhesions required significant additional work to perform. 50543 58740 BCBST Generic services integral to standard of medical/surgical services include lysis of simple adhesions. This code may be appropriate to reimburse in unusual clinical circumstances if review indicates that extensive adhesions were present and that an open lysis of adhesions was performed involving significant additional work. 50543 60650 NCCI 50543 62318 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 62319 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. Inappropriate Interpretation of CPT Code Definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 47 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50543 64415 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 64417 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 64450 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 64470 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 64475 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50543 69990 BCBST Operating microscope typically not required in performing the listed procedure, or is considered a part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 50543 90775 NCCI Standards of medical/surgical practice 50543 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50544 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 43653 NCCI CPT "separate procedure" definition 50544 44005 NCCI Misuse of column 2 code with column 1 code 50544 44180 NCCI HCPCS/CPT separate procedure definition 50544 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50544 50390 NCCI NCCI Most extensive procedures 50544 51701 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 48 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50544 51702 NCCI Standards of medical/surgical practice 50544 51703 NCCI Standards of medical/surgical practice 50544 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50544 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 64416 NCCI NCCI Refer to Specific Guidelines 50544 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50544 90775 NCCI Standards of medical/surgical practice 50544 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50545 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50545 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 49 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50545 35761 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 37202 NCCI 50545 38562 BCBST 50545 38564 NCCI 50545 38570 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 38770 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 38780 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 43653 NCCI 50545 44005 NCCI Misuse of column 2 code with column 1 code 50545 44180 NCCI HCPCS/CPT separate procedure definition 50545 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 50545 49320 BCBST NCCI HCPCS/CPT separate procedure definition / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 49321 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 49322 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50010 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50020 BCBST NCCI Most extensive procedures / The edited procedure involves only incidental additional work when performed with the listed procedure. 50545 50021 BCBST NCCI Most extensive procedures / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50040 BCBST NCCI Most extensive procedures / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50045 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50060 NCCI NCCI Most extensive procedures 50545 50065 NCCI NCCI Most extensive procedures 50545 50070 NCCI NCCI Most extensive procedures 50545 50075 NCCI NCCI Most extensive procedures 50545 50080 BCBST NCCI Most extensive procedures / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50081 BCBST NCCI Most extensive procedures / Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code / The edited code is a component of the listed code when performed as part of the listed procedure. NCCI Misuse of Column 2 code with Column 1 code CPT "separate procedure" definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 50 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50545 50100 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50120 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50125 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50205 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50220 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50230 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50240 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50280 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50290 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50370 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50390 NCCI 50545 50392 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50393 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50394 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50500 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50526 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50541 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50542 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50545 50543 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50545 50544 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50546 NCCI 50545 50547 BCBST NCCI Misuse of Column 2 code with Column 1 code / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50548 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50600 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50650 NCCI 50545 50650 BCBST NCCI Most extensive procedures NCCI Most extensive procedures HCPCS/CPT "separate procedure" definition The edited code is a component of the listed code when performed as part of the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 51 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50545 50700 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50545 50945 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50947 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 50948 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 51701 NCCI Standards of medical/surgical practice 50545 51702 NCCI Standards of medical/surgical practice 50545 51703 NCCI Standards of medical/surgical practice 50545 58660 BCBST NCCI HCPCS/CPT separate procedure definition / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50545 58740 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50545 60540 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 60545 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 60650 NCCI NCCI HCPCS/CPT procedure code definition 50545 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 64416 NCCI NCCI Refer to Specific Guidelines 50545 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50545 64475 NCCI 50545 69990 BCBST 50545 90775 NCCI Standards of medical/surgical practice 50545 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50546 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 43653 NCCI CPT "separate procedure" definition 50546 44005 NCCI Misuse of column 2 code with column 1 code 50546 44180 NCCI HCPCS/CPT separate procedure definition 50546 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50546 50020 NCCI NCCI Most extensive procedures 50546 50021 NCCI NCCI Most extensive procedures 50546 50040 NCCI NCCI Most extensive procedures 50546 50045 NCCI NCCI Most extensive procedures 50546 50060 NCCI NCCI Most extensive procedures 50546 50065 NCCI NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 52 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50546 50070 NCCI NCCI Most extensive procedures 50546 50075 NCCI NCCI Most extensive procedures 50546 50080 NCCI NCCI Most extensive procedures 50546 50081 NCCI NCCI Most extensive procedures 50546 50100 NCCI NCCI Most extensive procedures 50546 50205 NCCI NCCI Most extensive procedures 50546 50240 NCCI NCCI Most extensive procedures 50546 50390 NCCI NCCI Most extensive procedures 50546 50542 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50546 50543 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50546 50650 NCCI 50546 50947 BCBST This edit is considered a part of the more extensive listed procedure. 50546 50948 BCBST This edit is considered a part of the more extensive listed procedure. 50546 51701 NCCI Standards of medical/surgical practice 50546 51702 NCCI Standards of medical/surgical practice 50546 51703 NCCI Standards of medical/surgical practice 50546 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50546 60540 NCCI Inappropriate Interpretation of CPT Code Definition 50546 60545 NCCI Inappropriate Interpretation of CPT Code Definition 50546 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50546 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 64416 NCCI NCCI Refer to Specific Guidelines 50546 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50546 90775 NCCI Standards of medical/surgical practice 50546 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50547 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 43653 NCCI CPT "separate procedure" definition 50547 44005 NCCI Misuse of column 2 code with column 1 code 50547 44180 NCCI HCPCS/CPT separate procedure definition 50547 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50547 50542 BCBST NCCI Misuse of Column 2 code with Column 1 code This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 53 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50547 50543 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50547 50546 NCCI 50547 50650 NCCI 50547 50947 BCBST This edit is considered a part of the more extensive listed procedure. 50547 50948 BCBST This edit is considered a part of the more extensive listed procedure. 50547 51701 NCCI Standards of medical/surgical practice 50547 51702 NCCI Standards of medical/surgical practice 50547 51703 NCCI Standards of medical/surgical practice 50547 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50547 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 64416 NCCI NCCI Refer to Specific Guidelines 50547 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50547 90775 NCCI Standards of medical/surgical practice 50547 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50548 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 43653 NCCI CPT "separate procedure" definition 50548 44005 NCCI Misuse of column 2 code with column 1 code 50548 44180 NCCI HCPCS/CPT separate procedure definition 50548 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50548 50020 NCCI NCCI Most extensive procedures 50548 50021 NCCI NCCI Most extensive procedures 50548 50040 NCCI NCCI Most extensive procedures 50548 50045 NCCI NCCI Most extensive procedures 50548 50060 NCCI NCCI Most extensive procedures 50548 50065 NCCI NCCI Most extensive procedures 50548 50070 NCCI NCCI Most extensive procedures 50548 50075 NCCI NCCI Most extensive procedures 50548 50080 NCCI NCCI Most extensive procedures 50548 50081 NCCI NCCI Most extensive procedures 50548 50100 NCCI NCCI Most extensive procedures 50548 50205 NCCI NCCI Most extensive procedures 50548 50240 NCCI NCCI Most extensive procedures NCCI Mutually exclusive procedures HCPCS/CPT "separate procedure" definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 54 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50548 50390 NCCI 50548 50542 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50548 50543 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50548 50546 NCCI NCCI Most extensive procedures 50548 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50548 50660 NCCI 50548 50947 BCBST This edit is considered a part of the more extensive listed procedure. 50548 50948 BCBST This edit is considered a part of the more extensive listed procedure. 50548 51701 NCCI Standards of medical/surgical practice 50548 51702 NCCI Standards of medical/surgical practice 50548 51703 NCCI Standards of medical/surgical practice 50548 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50548 60540 NCCI Inappropriate Interpretation of CPT Code Definition 50548 60545 NCCI Inappropriate Interpretation of CPT Code Definition 50548 60650 NCCI Inappropriate Interpretation of CPT Code Definition 50548 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 64416 NCCI NCCI Refer to Specific Guidelines 50548 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50548 90775 NCCI Standards of medical/surgical practice 50548 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50549 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50551 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 50391 NCCI Most extensive procedure 50551 50394 NCCI NCCI Standards of medical / surgical practice 50551 50570 NCCI NCCI Mutually exclusive procedures 50551 50572 NCCI NCCI Mutually exclusive procedures 50551 50574 NCCI NCCI Mutually exclusive procedures 50551 50575 NCCI NCCI Mutually exclusive procedures 50551 50576 NCCI NCCI Mutually exclusive procedures 50551 50580 NCCI NCCI Mutually exclusive procedures 50551 50684 NCCI HCPCS/CPT procedure code definition NCCI Most extensive procedures NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 55 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50551 51701 NCCI Standards of medical/surgical practice 50551 51702 NCCI Standards of medical/surgical practice 50551 51703 NCCI Standards of medical/surgical practice 50551 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 64416 NCCI NCCI Refer to Specific Guidelines 50551 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50551 90775 NCCI Standards of medical/surgical practice 50551 J2001 NCCI Misuse of column 2 code with column 1 code 50551 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50553 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 50392 NCCI NCCI Standards of medical / surgical practice 50553 50395 NCCI NCCI Standards of medical / surgical practice 50553 50551 NCCI NCCI HCPCS/CPT procedure code definition 50553 50570 NCCI NCCI Mutually exclusive procedures 50553 50572 NCCI NCCI Mutually exclusive procedures 50553 50572 NCCI NCCI Mutually exclusive procedures 50553 50574 NCCI NCCI Mutually exclusive procedures 50553 50575 NCCI NCCI Mutually exclusive procedures 50553 50576 NCCI NCCI Mutually exclusive procedures 50553 50580 NCCI NCCI Mutually exclusive procedures 50553 50684 NCCI HCPCS/CPT procedure code definition 50553 51701 NCCI Standards of medical/surgical practice 50553 51702 NCCI Standards of medical/surgical practice 50553 51703 NCCI Standards of medical/surgical practice 50553 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 64416 NCCI NCCI Refer to Specific Guidelines 50553 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 56 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50553 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50553 90775 NCCI Standards of medical/surgical practice 50553 J2001 NCCI Misuse of column 2 code with column 1 code 50553 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50555 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 50392 NCCI NCCI Standards of medical / surgical practice 50555 50394 NCCI NCCI Standards of medical / surgical practice 50555 50395 NCCI NCCI Standards of medical / surgical practice 50555 50551 NCCI NCCI HCPCS/CPT procedure code definition 50555 50570 NCCI NCCI Mutually exclusive procedures 50555 50572 NCCI NCCI Mutually exclusive procedures 50555 50572 NCCI NCCI Mutually exclusive procedures 50555 50574 NCCI NCCI Mutually exclusive procedures 50555 50574 NCCI NCCI Mutually exclusive procedures 50555 50575 NCCI NCCI Mutually exclusive procedures 50555 50580 NCCI NCCI Mutually exclusive procedures 50555 50684 NCCI HCPCS/CPT procedure code definition 50555 51701 NCCI Standards of medical/surgical practice 50555 51702 NCCI Standards of medical/surgical practice 50555 51703 NCCI Standards of medical/surgical practice 50555 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 64416 NCCI NCCI Refer to Specific Guidelines 50555 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50555 Standards of medical/surgical practice 90775 NCCI 50555 J2001 NCCI Misuse of column 2 code with column 1 code 50555 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50557 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 50392 NCCI NCCI Standards of medical / surgical practice 50557 50394 NCCI NCCI Standards of medical / surgical practice 50557 50395 NCCI NCCI Standards of medical / surgical practice 50557 50551 NCCI NCCI HCPCS/CPT procedure code definition 50557 50555 NCCI NCCI HCPCS/CPT procedure code definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 57 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50557 50570 NCCI NCCI Mutually exclusive procedures 50557 50572 NCCI NCCI Mutually exclusive procedures 50557 50572 NCCI NCCI Mutually exclusive procedures 50557 50574 NCCI NCCI Mutually exclusive procedures 50557 50574 NCCI NCCI Mutually exclusive procedures 50557 50575 NCCI NCCI Mutually exclusive procedures 50557 50575 NCCI NCCI Mutually exclusive procedures 50557 50576 NCCI NCCI Mutually exclusive procedures 50557 50576 NCCI NCCI Mutually exclusive procedures 50557 50580 NCCI NCCI Mutually exclusive procedures 50557 50684 NCCI HCPCS/CPT procedure code definition 50557 50955 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 50974 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 51701 NCCI Standards of medical/surgical practice 50557 51702 NCCI Standards of medical/surgical practice 50557 51703 NCCI Standards of medical/surgical practice 50557 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 64416 NCCI NCCI Refer to Specific Guidelines 50557 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50557 90775 NCCI Standards of medical/surgical practice 50557 J2001 NCCI Misuse of column 2 code with column 1 code 50557 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50561 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 50392 NCCI NCCI Standards of medical / surgical practice 50561 50394 NCCI NCCI Standards of medical / surgical practice 50561 50395 NCCI NCCI Standards of medical / surgical practice 50561 50551 NCCI NCCI HCPCS/CPT procedure code definition 50561 50570 NCCI NCCI Mutually exclusive procedures 50561 50572 NCCI NCCI Mutually exclusive procedures 50561 50572 NCCI NCCI Mutually exclusive procedures 50561 50574 NCCI NCCI Mutually exclusive procedures 50561 50574 NCCI NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 58 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50561 50575 NCCI NCCI Mutually exclusive procedures 50561 50575 NCCI NCCI Mutually exclusive procedures 50561 50576 NCCI NCCI Mutually exclusive procedures 50561 50576 NCCI NCCI Mutually exclusive procedures 50561 50580 NCCI NCCI Mutually exclusive procedures 50561 50580 NCCI NCCI Mutually exclusive procedures 50561 50684 NCCI HCPCS/CPT procedure code definition 50561 51701 NCCI Standards of medical/surgical practice 50561 51702 NCCI Standards of medical/surgical practice 50561 51703 NCCI Standards of medical/surgical practice 50561 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 64416 NCCI NCCI Refer to Specific Guidelines 50561 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50561 90775 NCCI Standards of medical/surgical practice 50561 J2001 NCCI Misuse of column 2 code with column 1 code 50561 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50562 36000 BCBST Edited code not allowed if used to report incidental needle introduction at the time of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 50562 37202 BCBST The edited code is a component of the listed code if used to report minor anesthesia or infusion services provided as part of the listed procedure or according to surgical package instructions. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code policy, which indicates that a provider should not report a CPT code out of the context for which it was intended. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure. 50562 50392 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50562 50394 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50562 50395 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 50562 50551 BCBST Edited code not allowed if used to report endoscopy included in the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 59 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50562 50555 BCBST Edited code not allowed when used to report submission of surgical specimens for pathology or incidental biopsy at the time of the definitive procedure. When an endoscopic or open procedure is performed and a biopsy is also performed, followed by excision, destruction or removal of the biopsied lesion, the biopsy is not separately reported. This code may be appropriate to reimburse if performed with unrelated procedures, and if it involved significant additional work to justify reimbursement. 50562 50557 BCBST Edited code not allowed if used to report incidental fulguration included in the listed procedure. 50562 50561 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50570 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50572 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50574 BCBST Edited code not allowed when used to report submission of surgical specimens for pathology or incidental biopsy at the time of the definitive procedure. This code may be appropriate to reimburse if performed as a separate procedure involving significant additional work to justify reimbursement. 50562 50575 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50576 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50580 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 50562 50684 NCCI HCPCS/CPT procedure code definition 50562 51701 NCCI Standards of medical/surgical practice 50562 51702 NCCI Standards of medical/surgical practice 50562 51703 NCCI Standards of medical/surgical practice 50562 62318 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 62319 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 64415 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 60 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50562 64417 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 64450 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 64470 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 64475 BCBST This code should not be used to report local, topical or regional anesthetic admistered by the physician in the course of performing another procedure. Such anesthesia is considered integral to the performance of the procedure, and this code should not be used to report these services. Note, however, that it may be appropriate to reimburse this procedure if it is performed for indicated purposes separately from the comprehensive procedure; if this code represents a different anatomical region from the primary procedure, it may represent an appropriate service or a miscode. Review records for payment. 50562 69990 BCBST Operating microscope typically not required in performing the listed procedure, or is considered a part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 50562 90775 NCCI Standards of medical/surgical practice 50562 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50570 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 50391 NCCI Most extensive procedure 50570 50392 NCCI NCCI Standards of medical / surgical practice 50570 50394 NCCI NCCI Standards of medical / surgical practice 50570 50395 NCCI NCCI Standards of medical / surgical practice 50570 50684 NCCI HCPCS/CPT procedure code definition 50570 51701 NCCI Standards of medical/surgical practice 50570 51702 NCCI Standards of medical/surgical practice 50570 51703 NCCI Standards of medical/surgical practice 50570 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 61 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50570 64416 NCCI NCCI Refer to Specific Guidelines 50570 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50570 90775 NCCI Standards of medical/surgical practice 50570 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50572 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 50392 NCCI NCCI Standards of medical / surgical practice 50572 50395 NCCI NCCI Standards of medical / surgical practice 50572 50570 NCCI NCCI HCPCS/CPT procedure code definition 50572 50684 NCCI HCPCS/CPT procedure code definition 50572 51701 NCCI Standards of medical/surgical practice 50572 51702 NCCI Standards of medical/surgical practice 50572 51703 NCCI Standards of medical/surgical practice 50572 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 64416 NCCI NCCI Refer to Specific Guidelines 50572 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50572 90775 NCCI Standards of medical/surgical practice 50572 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50574 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 50392 NCCI NCCI Standards of medical / surgical practice 50574 50394 NCCI NCCI Standards of medical / surgical practice 50574 50395 NCCI NCCI Standards of medical / surgical practice 50574 50570 NCCI NCCI HCPCS/CPT procedure code definition 50574 50684 NCCI HCPCS/CPT procedure code definition 50574 51701 NCCI Standards of medical/surgical practice 50574 51702 NCCI Standards of medical/surgical practice 50574 51703 NCCI Standards of medical/surgical practice 50574 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 62 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50574 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 64416 NCCI NCCI Refer to Specific Guidelines 50574 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50574 90775 NCCI Standards of medical/surgical practice 50574 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50575 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 50382 NCCI Misuse of column 2 code with column 1 code 50575 50384 NCCI Misuse of column 2 code with column 1 code 50575 50387 NCCI Misuse of column 2 code with column 1 code 50575 50393 NCCI NCCI Standards of medical / surgical practice 50575 50395 NCCI NCCI Standards of medical / surgical practice 50575 50570 NCCI NCCI HCPCS/CPT procedure code definition 50575 50605 NCCI NCCI Standards of medical / surgical practice 50575 50684 NCCI HCPCS/CPT procedure code definition 50575 51701 NCCI Standards of medical/surgical practice 50575 51702 NCCI Standards of medical/surgical practice 50575 51703 NCCI Standards of medical/surgical practice 50575 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 64416 NCCI NCCI Refer to Specific Guidelines 50575 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50575 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50575 90775 NCCI Standards of medical/surgical practice 50575 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50576 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 50392 NCCI NCCI Standards of medical / surgical practice 50576 50395 NCCI NCCI Standards of medical / surgical practice 50576 50555 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 50570 NCCI NCCI HCPCS/CPT procedure code definition 50576 50574 NCCI NCCI HCPCS/CPT procedure code definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 63 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50576 50684 NCCI HCPCS/CPT procedure code definition 50576 50955 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 50974 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 51701 NCCI Standards of medical/surgical practice 50576 51702 NCCI Standards of medical/surgical practice 50576 51703 NCCI Standards of medical/surgical practice 50576 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 64416 NCCI NCCI Refer to Specific Guidelines 50576 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50576 90775 NCCI Standards of medical/surgical practice 50576 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50580 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 50392 NCCI NCCI Standards of medical / surgical practice 50580 50395 NCCI NCCI Standards of medical / surgical practice 50580 50570 NCCI NCCI HCPCS/CPT procedure code definition 50580 50684 NCCI HCPCS/CPT procedure code definition 50580 51701 NCCI Standards of medical/surgical practice 50580 51702 NCCI Standards of medical/surgical practice 50580 51703 NCCI Standards of medical/surgical practice 50580 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 64416 NCCI NCCI Refer to Specific Guidelines 50580 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50580 90775 NCCI Standards of medical/surgical practice 50580 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50590 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 51701 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 64 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50590 51702 NCCI Standards of medical/surgical practice 50590 51703 NCCI Standards of medical/surgical practice 50590 52000 NCCI NCCI HCPCS/CPT separate procedure definition 50590 52005 NCCI NCCI Standards of medical / surgical practice 50590 52320 NCCI NCCI Standards of medical / surgical practice 50590 52325 NCCI NCCI Standards of medical / surgical practice 50590 52330 NCCI NCCI Standards of medical / surgical practice 50590 52351 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 52352 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 52353 NCCI Mutually exclusive 50590 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 64416 NCCI NCCI Refer to Specific Guidelines 50590 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50590 76000 NCCI Standards of medical / surgical practice 50590 76001 NCCI Standards of medical / surgical practice 50590 90775 NCCI Standards of medical/surgical practice 50590 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50592 36000 NCCI Standards of medical/surgical practice 50592 36410 NCCI Standards of medical/surgical practice 50592 37202 NCCI Misuse of column 2 code with column 1 code 50592 43752 NCCI Misuse of column 2 code with column 1 code 50592 51701 NCCI Standards of medical/surgical practice 50592 51702 NCCI Standards of medical/surgical practice 50592 51703 NCCI Standards of medical/surgical practice 50592 62318 NCCI Misuse of column 2 code with column 1 code 50592 62319 NCCI Misuse of column 2 code with column 1 code 50592 64415 NCCI Misuse of column 2 code with column 1 code 50592 64416 NCCI Misuse of column 2 code with column 1 code 50592 64417 NCCI Misuse of column 2 code with column 1 code 50592 64450 NCCI Misuse of column 2 code with column 1 code 50592 64470 NCCI Misuse of column 2 code with column 1 code 50592 64475 NCCI Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 65 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50592 69990 NCCI Misuse of column 2 code with column 1 code 50592 76000 NCCI Misuse of column 2 code with column 1 code 50592 76001 NCCI Misuse of column 2 code with column 1 code 50592 76942 NCCI Misuse of column 2 code with column 1 code 50592 76998 NCCI Misuse of column 2 code with column 1 code 50592 77002 NCCI Misuse of column 2 code with column 1 code 50592 77012 NCCI Misuse of column 2 code with column 1 code 50592 77021 NCCI Misuse of column 2 code with column 1 code 50592 90775 NCCI Standards of medical/surgical practice 50592 93000 NCCI Standards of medical/surgical practice 50592 93005 NCCI Standards of medical/surgical practice 50592 93010 NCCI Standards of medical/surgical practice 50592 93040 NCCI Standards of medical/surgical practice 50592 93041 NCCI Standards of medical/surgical practice 50592 93042 NCCI Standards of medical/surgical practice 50592 94770 NCCI Standards of medical/surgical practice 50592 99143 NCCI HCPCS/CPT coding manual instruction/guideline 50592 99144 NCCI HCPCS/CPT coding manual instruction/guideline 50592 99145 NCCI HCPCS/CPT coding manual instruction/guideline 50592 99148 NCCI Standard preparation/monitoring services for anesthesia 50592 99149 NCCI Standard preparation/monitoring services for anesthesia 50592 99150 NCCI Standard preparation/monitoring services for anesthesia 50593 36000 NCCI Standards of medical/surgical practice 50593 36410 NCCI Standards of medical/surgical practice 50593 37202 NCCI Misuse of column 2 code with column 1 code 50593 62318 NCCI Misuse of column 2 code with column 1 code 50593 62319 NCCI Misuse of column 2 code with column 1 code 50593 64415 NCCI Misuse of column 2 code with column 1 code 50593 64416 NCCI Misuse of column 2 code with column 1 code 50593 64417 NCCI Misuse of column 2 code with column 1 code 50593 64450 NCCI Misuse of column 2 code with column 1 code 50593 64470 NCCI Misuse of column 2 code with column 1 code 50593 64475 NCCI Misuse of column 2 code with column 1 code 50593 69990 NCCI Misuse of column 2 code with column 1 code 50593 76000 NCCI Misuse of column 2 code with column 1 code 50593 76001 NCCI Misuse of column 2 code with column 1 code 50593 76942 NCCI Misuse of column 2 code with column 1 code 50593 76998 NCCI Misuse of column 2 code with column 1 code 50593 77002 NCCI Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 66 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50593 77012 NCCI Misuse of column 2 code with column 1 code 50593 77021 NCCI Misuse of column 2 code with column 1 code 50593 90775 NCCI Standards of medical/surgical practice 50593 93000 NCCI Standards of medical/surgical practice 50593 93005 NCCI Standards of medical/surgical practice 50593 93010 NCCI Standards of medical/surgical practice 50593 93040 NCCI Standards of medical/surgical practice 50593 93041 NCCI Standards of medical/surgical practice 50593 93042 NCCI Standards of medical/surgical practice 50593 94770 NCCI Standards of medical/surgical practice 50593 99143 NCCI CPT manual and CMS coding manual instructions 50593 99144 NCCI CPT manual and CMS coding manual instructions 50593 99145 NCCI CPT manual and CMS coding manual instructions 50593 99148 NCCI Standard preparation/monitoring services for anesthesia 50593 99149 NCCI Standard preparation/monitoring services for anesthesia 50593 99150 NCCI Standard preparation/monitoring services for anesthesia 50600 00910 NCCI NCCI Anesthesia included in surgical procedures 50600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 44602 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 44604 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 50600 44955 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 47100 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 49000 NCCI 50600 49002 BCBST 50600 49010 NCCI 50600 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 49320 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 49570 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 50010 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 50100 NCCI 50600 51700 BCBST 50600 51701 NCCI Standards of medical/surgical practice 50600 51702 NCCI Standards of medical/surgical practice 50600 51703 NCCI Standards of medical/surgical practice 50600 51705 BCBST NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 67 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50600 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 50600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 64416 NCCI NCCI Refer to Specific Guidelines 50600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50600 90775 NCCI Standards of medical/surgical practice 50600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50605 00910 NCCI NCCI Anesthesia included in surgical procedures 50605 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50605 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50605 49002 NCCI NCCI Standards of medical / surgical practice 50605 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50605 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50605 50382 NCCI Misuse of column 2 code with column 1 code 50605 50384 NCCI Misuse of column 2 code with column 1 code 50605 50387 NCCI Misuse of column 2 code with column 1 code 50605 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50605 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 51701 NCCI Standards of medical/surgical practice 50605 51702 NCCI Standards of medical/surgical practice 50605 51703 NCCI Standards of medical/surgical practice 50605 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 64416 NCCI NCCI Refer to Specific Guidelines 50605 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50605 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 68 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50605 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50610 00910 NCCI NCCI Anesthesia included in surgical procedures 50610 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50610 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50610 49002 NCCI NCCI Standards of medical / surgical practice 50610 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50610 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50610 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 50945 NCCI NCCI Sequential procedures 50610 51701 NCCI Standards of medical/surgical practice 50610 51702 NCCI Standards of medical/surgical practice 50610 51703 NCCI Standards of medical/surgical practice 50610 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 64416 NCCI NCCI Refer to Specific Guidelines 50610 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50610 90775 NCCI Standards of medical/surgical practice 50610 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50620 00910 NCCI NCCI Anesthesia included in surgical procedures 50620 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50620 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50620 49002 NCCI NCCI Standards of medical / surgical practice 50620 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50620 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50620 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 50945 NCCI NCCI Sequential procedures 50620 51701 NCCI Standards of medical/surgical practice 50620 51702 NCCI Standards of medical/surgical practice 50620 51703 NCCI Standards of medical/surgical practice 50620 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 69 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50620 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 64416 NCCI NCCI Refer to Specific Guidelines 50620 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50620 90775 NCCI Standards of medical/surgical practice 50620 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50630 00910 NCCI NCCI Anesthesia included in surgical procedures 50630 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50630 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50630 49002 NCCI NCCI Standards of medical / surgical practice 50630 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50630 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50630 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 50945 NCCI NCCI Sequential procedures 50630 51701 NCCI Standards of medical/surgical practice 50630 51702 NCCI Standards of medical/surgical practice 50630 51703 NCCI Standards of medical/surgical practice 50630 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 64416 NCCI NCCI Refer to Specific Guidelines 50630 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50630 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50630 90775 NCCI Standards of medical/surgical practice 50630 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50650 00910 NCCI NCCI Anesthesia included in surgical procedures 50650 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50650 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50650 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 51701 NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 70 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50650 51702 NCCI NCCI Refer to Specific Guidelines 50650 51703 NCCI Standards of medical/surgical practice 50650 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 64416 NCCI NCCI Refer to Specific Guidelines 50650 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50650 90775 NCCI Standards of medical/surgical practice 50650 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50660 00910 NCCI NCCI Anesthesia included in surgical procedures 50660 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50660 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50660 49002 NCCI NCCI Standards of medical / surgical practice 50660 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50660 50650 NCCI NCCI HCPCS/CPT separate procedure definition 50660 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 51701 NCCI Standards of medical / surgical practice 50660 51702 NCCI NCCI Refer to Specific Guidelines 50660 51703 NCCI Standards of medical/surgical practice 50660 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 64416 NCCI NCCI Refer to Specific Guidelines 50660 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50660 90775 NCCI Standards of medical/surgical practice 50660 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50684 00910 NCCI NCCI Anesthesia included in surgical procedures 50684 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 71 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50684 51701 NCCI Standards of medical/surgical practice 50684 51702 NCCI Standards of medical/surgical practice 50684 51703 NCCI Standards of medical/surgical practice 50684 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 64416 NCCI NCCI Refer to Specific Guidelines 50684 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50684 90775 NCCI Standards of medical/surgical practice 50684 J2001 NCCI Misuse of column 2 code with column 1 code 50684 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50686 00910 NCCI NCCI Anesthesia included in surgical procedures 50686 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 51701 NCCI Standards of medical/surgical practice 50686 51702 NCCI Standards of medical/surgical practice 50686 51703 NCCI Standards of medical/surgical practice 50686 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 64416 NCCI NCCI Refer to Specific Guidelines 50686 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50686 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50686 90775 NCCI Standards of medical/surgical practice 50686 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50688 00910 NCCI NCCI Anesthesia included in surgical procedures 50688 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 51701 NCCI Standards of medical/surgical practice 50688 51702 NCCI Standards of medical/surgical practice 50688 51703 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 72 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50688 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 64416 NCCI NCCI Refer to Specific Guidelines 50688 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50688 74425 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50688 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50688 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50688 90775 NCCI Standards of medical/surgical practice 50688 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50690 00910 NCCI NCCI Anesthesia included in surgical procedures 50690 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 51701 NCCI Standards of medical/surgical practice 50690 51702 NCCI Standards of medical/surgical practice 50690 51703 NCCI Standards of medical/surgical practice 50690 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 64416 NCCI NCCI Refer to Specific Guidelines 50690 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50690 Standards of medical/surgical practice 90775 NCCI 50690 J2001 NCCI Misuse of column 2 code with column 1 code 50690 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50700 00910 NCCI NCCI Anesthesia included in surgical procedures 50700 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50700 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50700 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50700 49002 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 73 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50700 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50700 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50700 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50700 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 50722 NCCI NCCI Standards of medical / surgical practice 50700 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50700 51701 NCCI Standards of medical/surgical practice 50700 51702 NCCI Standards of medical/surgical practice 50700 51703 NCCI Standards of medical/surgical practice 50700 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 64416 NCCI NCCI Refer to Specific Guidelines 50700 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50700 90775 NCCI Standards of medical/surgical practice 50700 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50715 00910 NCCI NCCI Anesthesia included in surgical procedures 50715 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50715 44180 NCCI HCPCS/CPT separate procedure definition 50715 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50715 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50715 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50715 49002 NCCI NCCI Standards of medical / surgical practice 50715 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50715 49203 NCCI Misuse of column 2 code with column 1 code 50715 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50715 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50715 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50715 51100 NCCI Misuse of column 2 code with column 1 code 50715 51101 NCCI Misuse of column 2 code with column 1 code 50715 51102 NCCI Misuse of column 2 code with column 1 code 50715 51701 NCCI Standards of medical/surgical practice 50715 51702 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 74 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50715 51703 NCCI Standards of medical/surgical practice 50715 52005 NCCI NCCI Standards of medical / surgical practice 50715 58570 NCCI Misuse of column 2 code with column 1 code 50715 58571 NCCI Misuse of column 2 code with column 1 code 50715 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 64416 NCCI NCCI Refer to Specific Guidelines 50715 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50715 90775 NCCI Standards of medical/surgical practice 50715 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50722 00910 NCCI NCCI Anesthesia included in surgical procedures 50722 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50722 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50722 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50722 49002 NCCI NCCI Standards of medical / surgical practice 50722 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50722 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50722 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50722 51701 NCCI Standards of medical/surgical practice 50722 51702 NCCI Standards of medical/surgical practice 50722 51703 NCCI Standards of medical/surgical practice 50722 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 64416 NCCI NCCI Refer to Specific Guidelines 50722 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50722 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 75 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50722 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50725 00910 NCCI NCCI Anesthesia included in surgical procedures 50725 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50725 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50725 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50725 49002 NCCI NCCI Standards of medical / surgical practice 50725 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50725 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50725 50600 NCCI NCCI HCPCS/CPT separate procedure definition 50725 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50725 51701 NCCI Standards of medical/surgical practice 50725 51702 NCCI Standards of medical/surgical practice 50725 51703 NCCI Standards of medical/surgical practice 50725 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 64416 NCCI NCCI Refer to Specific Guidelines 50725 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50725 90775 NCCI Standards of medical/surgical practice 50725 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50727 00910 NCCI NCCI Anesthesia included in surgical procedures 50727 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50727 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50727 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50727 49002 NCCI NCCI Standards of medical / surgical practice 50727 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50727 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 51701 NCCI Standards of medical/surgical practice 50727 51702 NCCI Standards of medical/surgical practice 50727 51703 NCCI Standards of medical/surgical practice 50727 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 76 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50727 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 64416 NCCI NCCI Refer to Specific Guidelines 50727 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50727 90775 NCCI Standards of medical/surgical practice 50727 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50728 00910 NCCI NCCI Anesthesia included in surgical procedures 50728 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50728 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50728 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50728 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50728 49002 NCCI NCCI Standards of medical / surgical practice 50728 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50728 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 50727 NCCI NCCI HCPCS/CPT procedure code definition 50728 50728 BCBST 50728 51701 NCCI Standards of medical/surgical practice 50728 51702 NCCI Standards of medical/surgical practice 50728 51703 NCCI Standards of medical/surgical practice 50728 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 64416 NCCI NCCI Refer to Specific Guidelines 50728 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50728 90775 NCCI Standards of medical/surgical practice 50728 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50740 00910 NCCI NCCI Anesthesia included in surgical procedures 50740 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 44850 NCCI NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 77 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50740 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50740 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50740 49002 NCCI NCCI Standards of medical / surgical practice 50740 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50740 50100 NCCI NCCI HCPCS/CPT separate procedure definition 50740 50650 NCCI HCPCS/CPT "separate procedure" definition 50740 50782 NCCI Mutually exclusive 50740 50800 NCCI Mutually exclusive 50740 50860 NCCI Mutually exclusive 50740 51701 NCCI Standards of medical/surgical practice 50740 51702 NCCI Standards of medical/surgical practice 50740 51703 NCCI Standards of medical/surgical practice 50740 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 64416 NCCI NCCI Refer to Specific Guidelines 50740 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50740 90775 NCCI Standards of medical/surgical practice 50740 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50750 00910 NCCI NCCI Anesthesia included in surgical procedures 50750 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50750 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50750 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50750 49002 NCCI NCCI Standards of medical / surgical practice 50750 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50750 50650 NCCI HCPCS/CPT "separate procedure" definition 50750 50740 NCCI Mutually exclusive 50750 50760 NCCI Mutually exclusive 50750 50780 NCCI Mutually exclusive 50750 50782 NCCI Mutually exclusive 50750 50800 NCCI Mutually exclusive 50750 50860 NCCI Mutually exclusive 50750 51701 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 78 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50750 51702 NCCI Standards of medical/surgical practice 50750 51703 NCCI Standards of medical/surgical practice 50750 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 64416 NCCI NCCI Refer to Specific Guidelines 50750 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50750 90775 NCCI Standards of medical/surgical practice 50750 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50760 00910 NCCI NCCI Anesthesia included in surgical procedures 50760 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50760 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50760 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50760 49002 NCCI NCCI Standards of medical / surgical practice 50760 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50760 50650 NCCI HCPCS/CPT "separate procedure" definition 50760 50740 NCCI Mutually exclusive 50760 50782 NCCI Mutually exclusive 50760 50800 NCCI Mutually exclusive 50760 50860 NCCI Mutually exclusive 50760 51701 NCCI Standards of medical/surgical practice 50760 51702 NCCI Standards of medical/surgical practice 50760 51703 NCCI Standards of medical/surgical practice 50760 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 64416 NCCI NCCI Refer to Specific Guidelines 50760 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50760 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 79 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50760 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50770 00910 NCCI NCCI Anesthesia included in surgical procedures 50770 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50770 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50770 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50770 49002 NCCI NCCI Standards of medical / surgical practice 50770 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50770 50650 NCCI HCPCS/CPT "separate procedure" definition 50770 50740 NCCI Mutually exclusive 50770 50750 NCCI Mutually exclusive 50770 50760 NCCI Mutually exclusive 50770 50780 NCCI Mutually exclusive 50770 50782 NCCI Mutually exclusive 50770 50783 NCCI Mutually exclusive 50770 50800 NCCI Mutually exclusive 50770 50860 NCCI Mutually exclusive 50770 51701 NCCI Standards of medical/surgical practice 50770 51702 NCCI Standards of medical/surgical practice 50770 51703 NCCI Standards of medical/surgical practice 50770 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 64416 NCCI NCCI Refer to Specific Guidelines 50770 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50770 90775 NCCI Standards of medical/surgical practice 50770 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50780 00910 NCCI NCCI Anesthesia included in surgical procedures 50780 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50780 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50780 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50780 49002 NCCI NCCI Standards of medical / surgical practice 50780 49010 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 80 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50780 50650 NCCI HCPCS/CPT "separate procedure" definition 50780 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 50740 NCCI Mutually exclusive 50780 50760 NCCI Mutually exclusive 50780 50947 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50780 50948 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50780 51701 NCCI Standards of medical / surgical practice 50780 51702 NCCI NCCI Refer to Specific Guidelines 50780 51703 NCCI Standards of medical/surgical practice 50780 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 64416 NCCI NCCI Refer to Specific Guidelines 50780 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50780 90775 NCCI Standards of medical/surgical practice 50780 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50782 00910 NCCI NCCI Anesthesia included in surgical procedures 50782 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50782 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50782 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50782 49002 NCCI NCCI Standards of medical / surgical practice 50782 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50782 50650 NCCI HCPCS/CPT "separate procedure" definition 50782 50715 NCCI 50782 50947 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50782 50948 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50782 51701 NCCI Standards of medical / surgical practice 50782 51702 NCCI NCCI Refer to Specific Guidelines 50782 51703 NCCI Standards of medical/surgical practice 50782 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 81 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50782 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 64416 NCCI NCCI Refer to Specific Guidelines 50782 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50782 90775 NCCI Standards of medical/surgical practice 50782 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50783 00910 NCCI NCCI Anesthesia included in surgical procedures 50783 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50783 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50783 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50783 49002 NCCI NCCI Standards of medical / surgical practice 50783 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50783 50650 NCCI HCPCS/CPT "separate procedure" definition 50783 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 50740 NCCI Mutually exclusive 50783 50750 NCCI Mutually exclusive 50783 50760 NCCI Mutually exclusive 50783 50947 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50783 50948 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50783 51701 NCCI Standards of medical / surgical practice 50783 51702 NCCI NCCI Refer to Specific Guidelines 50783 51703 NCCI Standards of medical/surgical practice 50783 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 64416 NCCI NCCI Refer to Specific Guidelines 50783 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50783 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50783 90775 NCCI Standards of medical/surgical practice 50783 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 82 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50785 00910 NCCI NCCI Anesthesia included in surgical procedures 50785 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50785 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50785 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50785 49002 NCCI NCCI Standards of medical / surgical practice 50785 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50785 50650 NCCI HCPCS/CPT "separate procedure" definition 50785 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 50740 NCCI Mutually exclusive 50785 50750 NCCI Mutually exclusive 50785 50760 NCCI Mutually exclusive 50785 50770 NCCI Mutually exclusive 50785 50947 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50785 50948 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 50785 51701 NCCI Standards of medical / surgical practice 50785 51702 NCCI NCCI Refer to Specific Guidelines 50785 51703 NCCI Standards of medical/surgical practice 50785 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 64416 NCCI NCCI Refer to Specific Guidelines 50785 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50785 90775 NCCI Standards of medical/surgical practice 50785 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50800 00910 NCCI NCCI Anesthesia included in surgical procedures 50800 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50800 44180 NCCI HCPCS/CPT separate procedure definition 50800 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50800 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50800 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50800 49000 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 83 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50800 49002 NCCI NCCI Standards of medical / surgical practice 50800 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50800 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50800 50650 NCCI HCPCS/CPT "separate procedure" definition 50800 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 50860 NCCI NCCI Mutually exclusive procedures 50800 51701 NCCI Standards of medical / surgical practice 50800 51702 NCCI NCCI Refer to Specific Guidelines 50800 51703 NCCI Standards of medical/surgical practice 50800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 64416 NCCI NCCI Refer to Specific Guidelines 50800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50800 90775 NCCI Standards of medical/surgical practice 50800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50810 00910 NCCI NCCI Anesthesia included in surgical procedures 50810 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50810 44180 NCCI HCPCS/CPT separate procedure definition 50810 44188 NCCI Mutually Exclusive 50810 44320 NCCI HCPCS/CPT coding manual instruction/guideline 50810 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50810 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50810 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50810 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50810 49002 NCCI NCCI Standards of medical / surgical practice 50810 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50810 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50810 50650 NCCI HCPCS/CPT "separate procedure" definition 50810 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 50740 NCCI Mutually exclusive 50810 50750 NCCI Mutually exclusive 50810 50760 NCCI Mutually exclusive CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 84 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50810 50770 NCCI Mutually exclusive 50810 50800 NCCI NCCI Most extensive procedures 50810 50820 NCCI NCCI Mutually exclusive procedures 50810 50825 NCCI NCCI Mutually exclusive procedures 50810 51701 NCCI Standards of medical / surgical practice 50810 51702 NCCI NCCI Refer to Specific Guidelines 50810 51703 NCCI Standards of medical/surgical practice 50810 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 64416 NCCI NCCI Refer to Specific Guidelines 50810 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50810 90775 NCCI Standards of medical/surgical practice 50810 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50815 00910 NCCI NCCI Anesthesia included in surgical procedures 50815 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50815 44180 NCCI HCPCS/CPT separate procedure definition 50815 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50815 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50815 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50815 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50815 49002 NCCI NCCI Standards of medical / surgical practice 50815 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50815 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50815 50650 NCCI HCPCS/CPT "separate procedure" definition 50815 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 50740 NCCI Mutually exclusive 50815 50750 NCCI Mutually exclusive 50815 50760 NCCI Mutually exclusive 50815 50770 NCCI Mutually exclusive 50815 50820 NCCI NCCI Mutually exclusive procedures 50815 50825 NCCI NCCI Mutually exclusive procedures 50815 51701 NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 85 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50815 51702 NCCI NCCI Refer to Specific Guidelines 50815 51703 NCCI Standards of medical/surgical practice 50815 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 64416 NCCI NCCI Refer to Specific Guidelines 50815 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50815 90775 NCCI Standards of medical/surgical practice 50815 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50820 00910 NCCI NCCI Anesthesia included in surgical procedures 50820 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50820 44180 NCCI HCPCS/CPT separate procedure definition 50820 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50820 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50820 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50820 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50820 49002 NCCI NCCI Standards of medical / surgical practice 50820 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50820 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50820 50650 NCCI HCPCS/CPT "separate procedure" definition 50820 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 50740 NCCI Mutually exclusive 50820 50750 NCCI Mutually exclusive 50820 50760 NCCI Mutually exclusive 50820 50770 NCCI Mutually exclusive 50820 50825 NCCI NCCI Mutually exclusive procedures 50820 51580 NCCI NCCI Mutually exclusive procedures 50820 51585 NCCI NCCI Mutually exclusive procedures 50820 51701 NCCI Standards of medical / surgical practice 50820 51702 NCCI NCCI Refer to Specific Guidelines 50820 51703 NCCI Standards of medical/surgical practice 50820 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 86 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50820 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 64416 NCCI NCCI Refer to Specific Guidelines 50820 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50820 90775 NCCI Standards of medical/surgical practice 50820 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50825 00910 NCCI NCCI Anesthesia included in surgical procedures 50825 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50825 44180 NCCI HCPCS/CPT separate procedure definition 50825 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50825 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50825 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50825 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50825 49002 NCCI NCCI Standards of medical / surgical practice 50825 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50825 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50825 50650 NCCI HCPCS/CPT "separate procedure" definition 50825 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 50740 NCCI Mutually exclusive 50825 50750 NCCI Mutually exclusive 50825 50760 NCCI Mutually exclusive 50825 50770 NCCI Mutually exclusive 50825 51701 NCCI Standards of medical / surgical practice 50825 51702 NCCI NCCI Refer to Specific Guidelines 50825 51703 NCCI Standards of medical/surgical practice 50825 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 64416 NCCI NCCI Refer to Specific Guidelines 50825 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50825 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 87 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50825 90775 NCCI Standards of medical/surgical practice 50825 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50830 00910 NCCI NCCI Anesthesia included in surgical procedures 50830 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50830 44180 NCCI HCPCS/CPT separate procedure definition 50830 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50830 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50830 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50830 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50830 49002 NCCI NCCI Standards of medical / surgical practice 50830 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50830 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50830 50650 NCCI HCPCS/CPT "separate procedure" definition 50830 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 50800 NCCI NCCI Most extensive procedures 50830 50810 NCCI NCCI Most extensive procedures 50830 50815 NCCI NCCI Most extensive procedures 50830 50860 NCCI NCCI Standards of medical / surgical practice 50830 51701 NCCI Standards of medical / surgical practice 50830 51702 NCCI NCCI Refer to Specific Guidelines 50830 51703 NCCI Standards of medical/surgical practice 50830 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 64416 NCCI NCCI Refer to Specific Guidelines 50830 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50830 90775 NCCI Standards of medical/surgical practice 50830 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50840 00910 NCCI NCCI Anesthesia included in surgical procedures 50840 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50840 44180 NCCI HCPCS/CPT separate procedure definition 50840 44820 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 88 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50840 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50840 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50840 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50840 49002 NCCI NCCI Standards of medical / surgical practice 50840 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50840 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50840 50650 NCCI HCPCS/CPT "separate procedure" definition 50840 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 51701 NCCI Standards of medical / surgical practice 50840 51702 NCCI NCCI Refer to Specific Guidelines 50840 51703 NCCI Standards of medical/surgical practice 50840 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 64416 NCCI NCCI Refer to Specific Guidelines 50840 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50840 90775 NCCI Standards of medical/surgical practice 50840 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50845 00910 NCCI NCCI Anesthesia included in surgical procedures 50845 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50845 44180 NCCI HCPCS/CPT separate procedure definition 50845 44820 NCCI NCCI HCPCS/CPT separate procedure definition 50845 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50845 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50845 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50845 49002 NCCI NCCI Standards of medical / surgical practice 50845 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50845 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50845 50650 NCCI HCPCS/CPT "separate procedure" definition 50845 50715 NCCI 50845 50845 BCBST 50845 51701 NCCI Standards of medical / surgical practice 50845 51702 NCCI NCCI Refer to Specific Guidelines NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 89 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50845 51703 NCCI Standards of medical/surgical practice 50845 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 64416 NCCI NCCI Refer to Specific Guidelines 50845 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50845 90775 NCCI Standards of medical/surgical practice 50845 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50860 00910 NCCI NCCI Anesthesia included in surgical procedures 50860 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50860 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50860 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50860 49002 NCCI NCCI Standards of medical / surgical practice 50860 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50860 50650 NCCI HCPCS/CPT "separate procedure" definition 50860 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 50810 NCCI NCCI Mutually exclusive procedures 50860 50815 NCCI NCCI Mutually exclusive procedures 50860 50820 NCCI NCCI Mutually exclusive procedures 50860 50825 NCCI NCCI Mutually exclusive procedures 50860 51701 NCCI Standards of medical / surgical practice 50860 51702 NCCI NCCI Refer to Specific Guidelines 50860 51703 NCCI Standards of medical/surgical practice 50860 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 64416 NCCI NCCI Refer to Specific Guidelines 50860 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50860 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 90 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50860 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50900 00910 NCCI NCCI Anesthesia included in surgical procedures 50900 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50900 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50900 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50900 49002 NCCI NCCI Standards of medical / surgical practice 50900 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50900 50650 NCCI HCPCS/CPT "separate procedure" definition 50900 51701 NCCI Standards of medical / surgical practice 50900 51702 NCCI NCCI Refer to Specific Guidelines 50900 51703 NCCI Standards of medical/surgical practice 50900 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 64416 NCCI NCCI Refer to Specific Guidelines 50900 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50900 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50900 90775 NCCI Standards of medical/surgical practice 50900 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50920 00910 NCCI NCCI Anesthesia included in surgical procedures 50920 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50920 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50920 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50920 49002 NCCI NCCI Standards of medical / surgical practice 50920 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50920 50650 NCCI HCPCS/CPT "separate procedure" definition 50920 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50920 51701 NCCI Standards of medical / surgical practice 50920 51702 NCCI NCCI Refer to Specific Guidelines 50920 51703 NCCI Standards of medical/surgical practice 50920 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 91 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50920 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 64416 NCCI NCCI Refer to Specific Guidelines 50920 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50920 90775 NCCI Standards of medical/surgical practice 50920 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50930 00910 NCCI NCCI Anesthesia included in surgical procedures 50930 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 44005 NCCI NCCI HCPCS/CPT separate procedure definition 50930 44180 NCCI HCPCS/CPT separate procedure definition 50930 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50930 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50930 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50930 49002 NCCI NCCI Standards of medical / surgical practice 50930 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50930 49255 NCCI NCCI HCPCS/CPT separate procedure definition 50930 50650 NCCI HCPCS/CPT "separate procedure" definition 50930 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50930 51701 NCCI Standards of medical / surgical practice 50930 51702 NCCI NCCI Refer to Specific Guidelines 50930 51703 NCCI Standards of medical/surgical practice 50930 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 64416 NCCI NCCI Refer to Specific Guidelines 50930 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50930 90775 NCCI Standards of medical/surgical practice 50930 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50940 00910 NCCI NCCI Anesthesia included in surgical procedures 50940 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 92 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50940 44850 NCCI NCCI HCPCS/CPT separate procedure definition 50940 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50940 49000 NCCI NCCI HCPCS/CPT separate procedure definition 50940 49002 NCCI NCCI Standards of medical / surgical practice 50940 49010 NCCI NCCI HCPCS/CPT separate procedure definition 50940 50650 NCCI HCPCS/CPT "separate procedure" definition 50940 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 50900 NCCI NCCI HCPCS/CPT separate procedure definition 50940 51701 NCCI Standards of medical / surgical practice 50940 51702 NCCI NCCI Refer to Specific Guidelines 50940 51703 NCCI Standards of medical/surgical practice 50940 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 64416 NCCI NCCI Refer to Specific Guidelines 50940 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50940 90775 NCCI Standards of medical/surgical practice 50940 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50945 00910 NCCI NCCI Anesthesia included in surgical procedures 50945 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 43653 NCCI CPT "separate procedure" definition 50945 44005 NCCI Misuse of column 2 code with column 1 code 50945 44180 NCCI HCPCS/CPT separate procedure definition 50945 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 50945 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 51701 NCCI Standards of medical/surgical practice 50945 51702 NCCI Standards of medical/surgical practice 50945 51703 NCCI Standards of medical/surgical practice 50945 58660 NCCI NCCI HCPCS/CPT separate procedure definition 50945 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 64416 NCCI NCCI Refer to Specific Guidelines 50945 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 93 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50945 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50945 90775 NCCI Standards of medical/surgical practice 50945 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50947 00910 NCCI NCCI Anesthesia included in surgical procedures 50947 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50947 37202 NCCI 50947 38570 BCBST 50947 43653 NCCI CPT "separate procedure" definition 50947 44005 NCCI Misuse of column 2 code with column 1 code 50947 44180 NCCI 50947 49010 BCBST NCCI Misuse of Column 2 code with Column 1 code The edited procedure involves only incidental additional work when performed with the listed procedure. HCPCS/CPT separate procedure definition The edited procedure involves only incidental additional work when performed with the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 94 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50947 49320 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 50947 49321 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50947 49322 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50947 50010 BCBST Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 50947 50382 NCCI Misuse of column 2 code with column 1 code 50947 50384 NCCI Misuse of column 2 code with column 1 code 50947 50387 NCCI Misuse of column 2 code with column 1 code 50947 50394 NCCI NCCI Standards of medical / surgical practice 50947 50600 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 50605 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 50650 NCCI 50947 50650 BCBST 50947 50684 NCCI 50947 50700 BCBST 50947 50715 NCCI 50947 50945 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50947 50948 BCBST The edited code is a component of the listed code when performed during the same session. 50948 and code 52332 rebundle to 50947. 50947 51700 NCCI NCCI Standards of medical / surgical practice 50947 51701 NCCI Standards of medical / surgical practice 50947 51702 NCCI NCCI Refer to Specific Guidelines 50947 51703 NCCI Standards of medical / surgical practice 50947 52000 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 50947 52005 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 52281 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 52332 BCBST NCCI HCPCS/CPT procedure code definition / This code is a component of the listed code when performed during the same session. 50948 and 52332 rebundle to 50947. 50947 52341 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 52351 BCBST Component procedure if used to report services at the same session as the listed procedure. 50947 53660 NCCI HCPCS/CPT "separate procedure" definition The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI Standards of medical / surgical practice Component procedure if used to report services at the same session as the listed procedure. NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 95 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50947 53661 NCCI NCCI Standards of medical / surgical practice 50947 53665 NCCI NCCI Standards of medical / surgical practice 50947 58660 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 50947 58740 BCBST Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 50947 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 64416 NCCI NCCI Refer to Specific Guidelines 50947 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50947 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 50947 90775 NCCI Standards of medical/surgical practice 50947 P9612 NCCI NCCI Standards of medical / surgical practice 50947 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50948 00910 NCCI 50948 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. NCCI Anesthesia included in surgical procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 96 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50948 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 50948 37202 NCCI 50948 38570 BCBST 50948 43653 NCCI CPT "separate procedure" definition 50948 44005 NCCI Misuse of column 2 code with column 1 code 50948 44180 NCCI 50948 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 50948 49320 BCBST NCCI HCPCS/CPT separate procedure definition / The edited code is a component of the listed code when performed as part of the listed procedure. 50948 49321 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50948 49322 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50948 50010 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 50394 NCCI 50948 50600 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 50605 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 50650 NCCI 50948 50650 BCBST 50948 50684 NCCI 50948 50700 BCBST 50948 50715 NCCI 50948 50945 BCBST 50948 51700 NCCI 50948 51701 NCCI Standards of medical / surgical practice 50948 51702 NCCI NCCI Refer to Specific Guidelines 50948 51703 NCCI Standards of medical / surgical practice 50948 52000 BCBST NCCI Misuse of Column 2 code with Column 1 code The edited procedure involves only incidental additional work when performed with the listed procedure. HCPCS/CPT separate procedure definition NCCI Misuse of Column 2 code with Column 1 code HCPCS/CPT "separate procedure" definition The edited code is a component of the listed code when performed as part of the listed procedure. NCCI Misuse of Column 2 code with Column 1 code The edited code is a component of the listed code when performed as part of the listed procedure. NCCI Misuse of Column 2 code with Column 1 code The edited code is a component of the listed code when performed as part of the listed procedure. NCCI Standards of medical / surgical practice NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 97 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50948 52005 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 52281 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 52332 NCCI 50948 52341 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 52351 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 50948 53660 NCCI NCCI Standards of medical / surgical practice 50948 53661 NCCI NCCI Standards of medical / surgical practice 50948 53665 NCCI NCCI Standards of medical / surgical practice 50948 58660 BCBST NCCI HCPCS/CPT separate procedure definition / Clinically unlikely code combination or component. Review before reimbursing the edited code. 50948 58740 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 50948 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 64416 NCCI NCCI Refer to Specific Guidelines 50948 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50948 64475 NCCI 50948 69990 BCBST 50948 90775 NCCI 50948 P9612 NCCI NCCI Standards of medical / surgical practice 50948 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50949 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50951 00910 NCCI NCCI Anesthesia included in surgical procedures 50951 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 50391 NCCI Most extensive procedure 50951 50684 NCCI HCPCS/CPT procedure code definition 50951 51701 NCCI Standards of medical/surgical practice 50951 51702 NCCI Standards of medical/surgical practice 50951 51703 NCCI Standards of medical/surgical practice 50951 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT procedure code definition NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 98 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50951 64416 NCCI NCCI Refer to Specific Guidelines 50951 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50951 90775 NCCI Standards of medical/surgical practice 50951 J2001 NCCI Misuse of column 2 code with column 1 code 50951 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50953 00910 NCCI NCCI Anesthesia included in surgical procedures 50953 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 50684 NCCI HCPCS/CPT procedure code definition 50953 50951 NCCI NCCI HCPCS/CPT procedure code definition 50953 51701 NCCI Standards of medical/surgical practice 50953 51702 NCCI Standards of medical/surgical practice 50953 51703 NCCI Standards of medical/surgical practice 50953 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 64416 NCCI NCCI Refer to Specific Guidelines 50953 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50953 90775 NCCI Standards of medical/surgical practice 50953 J2001 NCCI Misuse of column 2 code with column 1 code 50953 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50955 00910 NCCI NCCI Anesthesia included in surgical procedures 50955 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 50684 NCCI HCPCS/CPT procedure code definition 50955 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 50951 NCCI NCCI HCPCS/CPT procedure code definition 50955 51701 NCCI Standards of medical/surgical practice 50955 51702 NCCI Standards of medical/surgical practice 50955 51703 NCCI Standards of medical/surgical practice 50955 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 99 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50955 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 64416 NCCI NCCI Refer to Specific Guidelines 50955 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50955 90775 NCCI Standards of medical/surgical practice 50955 J2001 NCCI Misuse of column 2 code with column 1 code 50955 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50957 00910 NCCI NCCI Anesthesia included in surgical procedures 50957 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 50684 NCCI HCPCS/CPT procedure code definition 50957 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 50951 NCCI NCCI HCPCS/CPT procedure code definition 50957 50955 NCCI NCCI HCPCS/CPT procedure code definition 50957 50974 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 51701 NCCI Standards of medical/surgical practice 50957 51702 NCCI Standards of medical/surgical practice 50957 51703 NCCI Standards of medical/surgical practice 50957 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 64416 NCCI NCCI Refer to Specific Guidelines 50957 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50957 Standards of medical/surgical practice 90775 NCCI 50957 J2001 NCCI Misuse of column 2 code with column 1 code 50957 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50961 00910 NCCI NCCI Anesthesia included in surgical procedures 50961 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 50684 NCCI HCPCS/CPT procedure code definition 50961 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 50951 NCCI NCCI HCPCS/CPT procedure code definition 50961 51701 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 100 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50961 51702 NCCI Standards of medical/surgical practice 50961 51703 NCCI Standards of medical/surgical practice 50961 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 64416 NCCI NCCI Refer to Specific Guidelines 50961 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50961 90775 NCCI Standards of medical/surgical practice 50961 J2001 NCCI Misuse of column 2 code with column 1 code 50961 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50970 00910 NCCI NCCI Anesthesia included in surgical procedures 50970 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 50391 NCCI Most extensive procedure 50970 50684 NCCI HCPCS/CPT procedure code definition 50970 51701 NCCI Standards of medical/surgical practice 50970 51702 NCCI Standards of medical/surgical practice 50970 51703 NCCI Standards of medical/surgical practice 50970 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 64416 NCCI NCCI Refer to Specific Guidelines 50970 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50970 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 50970 90775 NCCI Standards of medical/surgical practice 50970 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50972 00910 NCCI NCCI Anesthesia included in surgical procedures 50972 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 50684 NCCI HCPCS/CPT procedure code definition 50972 50970 NCCI NCCI HCPCS/CPT procedure code definition 50972 51701 NCCI Standards of medical/surgical practice 50972 51702 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 101 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50972 51703 NCCI Standards of medical/surgical practice 50972 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 64416 NCCI NCCI Refer to Specific Guidelines 50972 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50972 90775 NCCI Standards of medical/surgical practice 50972 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50974 00910 NCCI NCCI Anesthesia included in surgical procedures 50974 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 50684 NCCI HCPCS/CPT procedure code definition 50974 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 50970 NCCI NCCI HCPCS/CPT procedure code definition 50974 51701 NCCI Standards of medical/surgical practice 50974 51702 NCCI Standards of medical/surgical practice 50974 51703 NCCI Standards of medical/surgical practice 50974 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 64416 NCCI NCCI Refer to Specific Guidelines 50974 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50974 90775 NCCI Standards of medical/surgical practice 50974 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50976 00910 NCCI NCCI Anesthesia included in surgical procedures 50976 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 50684 NCCI HCPCS/CPT procedure code definition 50976 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 50955 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 50970 NCCI NCCI HCPCS/CPT procedure code definition 50976 50974 NCCI NCCI HCPCS/CPT procedure code definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 102 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 50976 51701 NCCI Standards of medical/surgical practice 50976 51702 NCCI Standards of medical/surgical practice 50976 51703 NCCI Standards of medical/surgical practice 50976 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 64416 NCCI NCCI Refer to Specific Guidelines 50976 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50976 90775 NCCI Standards of medical/surgical practice 50976 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 50980 00910 NCCI NCCI Anesthesia included in surgical procedures 50980 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 50684 NCCI HCPCS/CPT procedure code definition 50980 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 50970 NCCI NCCI HCPCS/CPT procedure code definition 50980 51701 NCCI Standards of medical/surgical practice 50980 51702 NCCI Standards of medical/surgical practice 50980 51703 NCCI Standards of medical/surgical practice 50980 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 64416 NCCI NCCI Refer to Specific Guidelines 50980 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 50980 90775 NCCI Standards of medical/surgical practice 50980 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51020 00910 NCCI NCCI Anesthesia included in surgical procedures 51020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51020 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51020 49002 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 103 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51020 50715 NCCI 51020 51020 BCBST 51020 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51020 51100 NCCI Most extensive procedure 51020 51101 NCCI Most extensive procedure 51020 51102 NCCI Most extensive procedure 51020 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51020 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51020 51701 NCCI Standards of medical / surgical practice 51020 51702 NCCI NCCI Refer to Specific Guidelines 51020 51703 NCCI Standards of medical/surgical practice 51020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 64416 NCCI NCCI Refer to Specific Guidelines 51020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51020 90775 NCCI Standards of medical/surgical practice 51020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51030 00910 NCCI NCCI Anesthesia included in surgical procedures 51030 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51030 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51030 49002 NCCI NCCI Standards of medical / surgical practice 51030 50715 NCCI 51030 51030 BCBST 51030 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51030 51100 NCCI Most extensive procedure 51030 51101 NCCI Most extensive procedure 51030 51102 NCCI Most extensive procedure 51030 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51030 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51030 51701 NCCI Standards of medical / surgical practice 51030 51702 NCCI NCCI Refer to Specific Guidelines 51030 51703 NCCI Standards of medical/surgical practice NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 104 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51030 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 64416 NCCI NCCI Refer to Specific Guidelines 51030 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51030 90775 NCCI Standards of medical/surgical practice 51030 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51040 00910 NCCI NCCI Anesthesia included in surgical procedures 51040 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51040 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51040 49002 NCCI NCCI Standards of medical / surgical practice 51040 50715 NCCI 51040 51040 BCBST 51040 51100 NCCI Most extensive procedure 51040 51101 NCCI Most extensive procedure 51040 51102 NCCI Most extensive procedure 51040 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51040 51701 NCCI Standards of medical / surgical practice 51040 51702 NCCI NCCI Refer to Specific Guidelines 51040 51703 NCCI Standards of medical/surgical practice 51040 52000 NCCI NCCI HCPCS/CPT separate procedure definition 51040 52005 NCCI NCCI Standards of medical / surgical practice 51040 52276 NCCI NCCI Standards of medical / surgical practice 51040 52281 NCCI NCCI Standards of medical / surgical practice 51040 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 64416 NCCI NCCI Refer to Specific Guidelines 51040 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51040 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 105 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51040 90775 NCCI Standards of medical/surgical practice 51040 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51045 00910 NCCI NCCI Anesthesia included in surgical procedures 51045 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51045 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51045 49002 NCCI NCCI Standards of medical / surgical practice 51045 50715 NCCI 51045 51045 BCBST 51045 51701 NCCI Standards of medical / surgical practice 51045 51702 NCCI NCCI Refer to Specific Guidelines 51045 51703 NCCI Standards of medical/surgical practice 51045 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 64416 NCCI NCCI Refer to Specific Guidelines 51045 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51045 NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. 69990 NCCI 51045 90775 NCCI Standards of medical/surgical practice 51045 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51050 00910 NCCI NCCI Anesthesia included in surgical procedures 51050 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51050 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51050 49002 NCCI NCCI Standards of medical / surgical practice 51050 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51050 51050 BCBST 51050 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51050 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51050 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51050 51701 NCCI Standards of medical / surgical practice 51050 51702 NCCI NCCI Refer to Specific Guidelines 51050 51703 NCCI Standards of medical/surgical practice 51050 52000 NCCI NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 106 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51050 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 64416 NCCI NCCI Refer to Specific Guidelines 51050 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51050 90775 NCCI Standards of medical/surgical practice 51050 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51060 00910 NCCI NCCI Anesthesia included in surgical procedures 51060 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51060 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51060 49002 NCCI NCCI Standards of medical / surgical practice 51060 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51060 51060 BCBST 51060 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51060 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51060 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51060 51701 NCCI Standards of medical / surgical practice 51060 51702 NCCI NCCI Refer to Specific Guidelines 51060 51703 NCCI Standards of medical/surgical practice 51060 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 64416 NCCI NCCI Refer to Specific Guidelines 51060 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51060 90775 NCCI Standards of medical/surgical practice 51060 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51065 00910 NCCI NCCI Anesthesia included in surgical procedures 51065 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 107 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51065 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51065 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51065 49002 NCCI NCCI Standards of medical / surgical practice 51065 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51065 51065 BCBST 51065 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51065 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51065 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51065 51701 NCCI Standards of medical / surgical practice 51065 51702 NCCI NCCI Refer to Specific Guidelines 51065 51703 NCCI Standards of medical/surgical practice 51065 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 64416 NCCI NCCI Refer to Specific Guidelines 51065 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51065 90775 NCCI Standards of medical/surgical practice 51065 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51080 00910 NCCI NCCI Anesthesia included in surgical procedures 51080 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51080 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51080 49002 NCCI NCCI Standards of medical / surgical practice 51080 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51080 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51080 51701 NCCI Standards of medical / surgical practice 51080 51702 NCCI NCCI Refer to Specific Guidelines 51080 51703 NCCI Standards of medical/surgical practice 51080 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 64416 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 108 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51080 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51080 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 51080 90775 NCCI Standards of medical/surgical practice 51080 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51100 00910 NCCI Anesthesia service included in surgical procedure 51100 36000 NCCI Standards of medical/surgical practice 51100 36410 NCCI Standards of medical/surgical practice 51100 37202 NCCI Misuse of column 2 code with column 1 code 51100 51701 NCCI Standards of medical/surgical practice 51100 62318 NCCI Misuse of column 2 code with column 1 code 51100 62319 NCCI Misuse of column 2 code with column 1 code 51100 64415 NCCI Misuse of column 2 code with column 1 code 51100 64416 NCCI Misuse of column 2 code with column 1 code 51100 64417 NCCI Misuse of column 2 code with column 1 code 51100 64450 NCCI Misuse of column 2 code with column 1 code 51100 64470 NCCI Misuse of column 2 code with column 1 code 51100 64475 NCCI Misuse of column 2 code with column 1 code 51100 69990 NCCI Misuse of column 2 code with column 1 code 51100 90775 NCCI Standards of medical/surgical practice 51100 J2001 NCCI Misuse of column 2 code with column 1 code 51101 00910 NCCI Anesthesia service included in surgical procedure 51101 36000 NCCI Standards of medical/surgical practice 51101 36410 NCCI Standards of medical/surgical practice 51101 37202 NCCI Misuse of column 2 code with column 1 code 51101 51100 NCCI Standards of medical/surgical practice 51101 51701 NCCI Standards of medical/surgical practice 51101 62318 NCCI Misuse of column 2 code with column 1 code 51101 62319 NCCI Misuse of column 2 code with column 1 code 51101 64415 NCCI Misuse of column 2 code with column 1 code 51101 64416 NCCI Misuse of column 2 code with column 1 code 51101 64417 NCCI Misuse of column 2 code with column 1 code 51101 64450 NCCI Misuse of column 2 code with column 1 code 51101 64470 NCCI Misuse of column 2 code with column 1 code 51101 64475 NCCI Misuse of column 2 code with column 1 code 51101 69990 NCCI Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 109 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51101 76000 NCCI Misuse of column 2 code with column 1 code 51101 90775 NCCI Standards of medical/surgical practice 51101 J2001 NCCI Misuse of column 2 code with column 1 code 51102 00910 NCCI Anesthesia service included in surgical procedure 51102 36000 NCCI Standards of medical/surgical practice 51102 36410 NCCI Standards of medical/surgical practice 51102 37202 NCCI Misuse of column 2 code with column 1 code 51102 51100 NCCI Standards of medical/surgical practice 51102 51101 NCCI Mutually exclusive procedures 51102 51701 NCCI Standards of medical/surgical practice 51102 51702 NCCI Standards of medical/surgical practice 51102 52281 NCCI Most extensive procedure 51102 62318 NCCI Misuse of column 2 code with column 1 code 51102 62319 NCCI Misuse of column 2 code with column 1 code 51102 64415 NCCI Misuse of column 2 code with column 1 code 51102 64416 NCCI Misuse of column 2 code with column 1 code 51102 64417 NCCI Misuse of column 2 code with column 1 code 51102 64450 NCCI Misuse of column 2 code with column 1 code 51102 64470 NCCI Misuse of column 2 code with column 1 code 51102 64475 NCCI Misuse of column 2 code with column 1 code 51102 69990 NCCI Misuse of column 2 code with column 1 code 51102 76000 NCCI Misuse of column 2 code with column 1 code 51102 90775 NCCI Standards of medical/surgical practice 51102 J2001 NCCI Misuse of column 2 code with column 1 code 51500 00910 NCCI NCCI Anesthesia included in surgical procedures 51500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51500 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51500 49002 NCCI NCCI Standards of medical / surgical practice 51500 49580 NCCI NCCI Standards of medical / surgical practice 51500 49582 NCCI NCCI Standards of medical / surgical practice 51500 49585 NCCI NCCI Standards of medical / surgical practice 51500 49587 NCCI NCCI Standards of medical / surgical practice 51500 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 51045 NCCI 51500 51500 BCBST 51500 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51500 51701 NCCI Standards of medical / surgical practice 51500 51702 NCCI NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 110 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51500 51703 NCCI Standards of medical/surgical practice 51500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 64416 NCCI NCCI Refer to Specific Guidelines 51500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51500 90775 NCCI Standards of medical/surgical practice 51500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51520 00910 NCCI NCCI Anesthesia included in surgical procedures 51520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51520 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51520 49002 NCCI NCCI Standards of medical / surgical practice 51520 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 51045 NCCI 51520 51520 BCBST OB-GYN procedure redundant to itself. 51520 51701 NCCI Standards of medical / surgical practice 51520 51702 NCCI NCCI Refer to Specific Guidelines 51520 51703 NCCI Standards of medical/surgical practice 51520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 64416 NCCI NCCI Refer to Specific Guidelines 51520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51520 90775 NCCI Standards of medical/surgical practice 51520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51525 00910 NCCI NCCI Anesthesia included in surgical procedures 51525 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51525 49000 NCCI NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 111 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51525 49002 NCCI NCCI Standards of medical / surgical practice 51525 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51525 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51525 51525 BCBST 51525 51701 NCCI Standards of medical / surgical practice 51525 51702 NCCI NCCI Refer to Specific Guidelines 51525 51703 NCCI Standards of medical/surgical practice 51525 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 64416 NCCI NCCI Refer to Specific Guidelines 51525 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51525 90775 NCCI Standards of medical/surgical practice 51525 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51530 00910 NCCI NCCI Anesthesia included in surgical procedures 51530 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51530 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51530 49002 NCCI NCCI Standards of medical / surgical practice 51530 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51530 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51530 51525 NCCI 51530 51530 BCBST 51530 51570 NCCI 51530 51701 NCCI Standards of medical / surgical practice 51530 51702 NCCI NCCI Refer to Specific Guidelines 51530 51703 NCCI Standards of medical/surgical practice 51530 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 64416 NCCI NCCI Refer to Specific Guidelines 51530 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 112 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51530 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51530 90775 NCCI Standards of medical/surgical practice 51530 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51535 00910 NCCI NCCI Anesthesia included in surgical procedures 51535 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51535 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51535 49002 NCCI NCCI Standards of medical / surgical practice 51535 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51535 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51535 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51535 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51535 51701 NCCI Standards of medical / surgical practice 51535 51702 NCCI NCCI Refer to Specific Guidelines 51535 51703 NCCI Standards of medical/surgical practice 51535 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 64416 NCCI NCCI Refer to Specific Guidelines 51535 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51535 90775 NCCI Standards of medical/surgical practice 51535 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51550 00910 NCCI NCCI Anesthesia included in surgical procedures 51550 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51550 44180 NCCI Standards of medical/surgical practice 51550 44680 BCBST 51550 44850 NCCI 51550 44950 BCBST OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 113 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51550 49000 NCCI 51550 49002 BCBST 51550 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51550 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51550 50650 NCCI HCPCS/CPT "separate procedure" definition 51550 50715 NCCI 51550 51040 BCBST 51550 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51550 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51550 51525 NCCI 51550 51550 BCBST 51550 51570 NCCI 51550 51701 NCCI Standards of medical / surgical practice 51550 51702 NCCI NCCI Refer to Specific Guidelines 51550 51703 NCCI 51550 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51550 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51550 58662 NCCI NCCI Most extensive procedures 51550 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 64416 NCCI NCCI Refer to Specific Guidelines 51550 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51550 90775 NCCI Standards of medical/surgical practice 51550 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51555 00910 NCCI NCCI Anesthesia included in surgical procedures 51555 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51555 44180 NCCI 51555 44680 BCBST 51555 44850 NCCI 51555 44950 BCBST 51555 49000 NCCI NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Standards of medical/surgical practice HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 114 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51555 49002 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 51555 49010 NCCI 51555 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51555 50650 NCCI HCPCS/CPT "separate procedure" definition 51555 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 51040 BCBST 51555 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51555 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51555 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51555 51550 NCCI 51555 51555 BCBST 51555 51570 NCCI 51555 51701 NCCI Standards of medical / surgical practice 51555 51702 NCCI NCCI Refer to Specific Guidelines 51555 51703 NCCI 51555 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51555 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51555 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51555 58662 NCCI NCCI Most extensive procedures 51555 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 64416 NCCI NCCI Refer to Specific Guidelines 51555 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51555 90775 NCCI Standards of medical/surgical practice 51555 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51565 00910 NCCI NCCI Anesthesia included in surgical procedures 51565 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 44680 BCBST 51565 44850 NCCI 51565 44950 BCBST 51565 49000 NCCI 51565 49002 BCBST NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Most extensive procedures OB-GYN procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Standards of medical/surgical practice OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 115 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51565 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51565 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51565 50650 NCCI HCPCS/CPT "separate procedure" definition 51565 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 51040 BCBST 51565 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51565 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51565 51525 NCCI 51565 51555 BCBST OB-GYN procedure -- standard subset procedure rationale. 51565 51565 BCBST Code redundant to self/should not be reported more than once due to standard description 51565 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51565 51701 NCCI Standards of medical / surgical practice 51565 51702 NCCI NCCI Refer to Specific Guidelines 51565 51703 NCCI Standards of medical/surgical practice 51565 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51565 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51565 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51565 58662 NCCI NCCI Most extensive procedures 51565 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 64416 NCCI NCCI Refer to Specific Guidelines 51565 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51565 90775 NCCI Standards of medical/surgical practice 51565 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51570 00910 NCCI NCCI Anesthesia included in surgical procedures 51570 37202 NCCI 51570 44680 BCBST 51570 44850 NCCI 51570 44950 BCBST 51570 49000 NCCI 51570 49002 BCBST 51570 49010 NCCI OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 116 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51570 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51570 50650 NCCI HCPCS/CPT "separate procedure" definition 51570 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 50800 NCCI NCCI Standards of medical / surgical practice 51570 50810 NCCI NCCI Standards of medical / surgical practice 51570 50825 NCCI NCCI Standards of medical / surgical practice 51570 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51570 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51570 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51570 51570 BCBST OB-GYN procedure redundant to itself. 51570 51701 NCCI Standards of medical / surgical practice 51570 51702 NCCI NCCI Refer to Specific Guidelines 51570 51703 NCCI Standards of medical/surgical practice 51570 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51570 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51570 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51570 58662 NCCI NCCI Most extensive procedures 51570 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 64416 NCCI NCCI Refer to Specific Guidelines 51570 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51570 90775 NCCI Standards of medical/surgical practice 51570 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51575 00910 NCCI NCCI Anesthesia included in surgical procedures 51575 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 38571 NCCI NCCI Most extensive procedures 51575 38572 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 38770 NCCI 51575 38780 BCBST 51575 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51575 44180 NCCI HCPCS/CPT separate procedure definition 51575 44680 BCBST 51575 44820 NCCI NCCI Most extensive procedures NCCI Misuse of Column 2 code with Column 1 code / OB-GYN procedure -standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 117 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51575 44850 NCCI 51575 44950 BCBST 51575 49000 NCCI 51575 49002 BCBST 51575 49010 NCCI 51575 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51575 50650 NCCI HCPCS/CPT "separate procedure" definition 51575 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 50800 NCCI NCCI Standards of medical / surgical practice 51575 50810 NCCI NCCI Standards of medical / surgical practice 51575 50825 NCCI NCCI Standards of medical / surgical practice 51575 51040 BCBST 51575 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51575 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51575 51550 BCBST 51575 51555 NCCI NCCI HCPCS/CPT procedure code definition 51575 51565 NCCI NCCI HCPCS/CPT procedure code definition 51575 51570 NCCI NCCI HCPCS/CPT procedure code definition 51575 51575 BCBST 51575 51701 NCCI Standards of medical / surgical practice 51575 51702 NCCI NCCI Refer to Specific Guidelines 51575 51703 NCCI 51575 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51575 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51575 58662 NCCI NCCI Most extensive procedures 51575 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 64416 NCCI NCCI Refer to Specific Guidelines 51575 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51575 90775 NCCI Standards of medical/surgical practice 51575 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51580 00910 NCCI NCCI Anesthesia included in surgical procedures NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. Code redundant to self/should not be reported more than once due to standard description Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 118 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51580 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51580 44180 NCCI 51580 44680 BCBST 51580 44820 NCCI 51580 44850 NCCI 51580 44950 BCBST 51580 49000 NCCI 51580 49002 BCBST 51580 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51580 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51580 50600 BCBST 51580 50650 NCCI HCPCS/CPT "separate procedure" definition 51580 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 50800 NCCI NCCI Standards of medical / surgical practice 51580 50810 NCCI NCCI Standards of medical / surgical practice 51580 50825 NCCI 51580 51040 BCBST 51580 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51580 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51580 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51580 51550 NCCI NCCI HCPCS/CPT procedure code definition 51580 51555 NCCI NCCI HCPCS/CPT procedure code definition 51580 51565 NCCI NCCI HCPCS/CPT procedure code definition 51580 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51580 51575 BCBST OB-GYN procedure -- standard subset procedure rationale. 51580 51580 BCBST Code redundant to self/should not be reported more than once due to standard description 51580 51701 NCCI Standards of medical / surgical practice 51580 51702 NCCI NCCI Refer to Specific Guidelines 51580 51703 NCCI Standards of medical/surgical practice 51580 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51580 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51580 58662 NCCI NCCI Most extensive procedures 51580 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 64416 NCCI NCCI Refer to Specific Guidelines HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. NCCI Standards of medical / surgical practice OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 119 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51580 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51580 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 51580 90775 NCCI Standards of medical/surgical practice 51580 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51585 00910 NCCI NCCI Anesthesia included in surgical procedures 51585 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 38571 NCCI NCCI Most extensive procedures 51585 38572 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 38770 NCCI NCCI Most extensive procedures 51585 38780 BCBST 51585 44005 NCCI 51585 44180 NCCI 51585 44680 BCBST 51585 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51585 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51585 44950 BCBST 51585 49000 NCCI 51585 49002 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 51585 49010 BCBST OB-GYN procedure -- standard subset procedure rationale. 51585 49255 NCCI 51585 50650 NCCI HCPCS/CPT "separate procedure" definition 51585 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 50800 NCCI NCCI Standards of medical / surgical practice 51585 50810 NCCI NCCI Standards of medical / surgical practice 51585 50825 NCCI NCCI Standards of medical / surgical practice 51585 51040 BCBST 51585 51045 NCCI 51585 51520 BCBST 51585 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51585 51550 NCCI NCCI HCPCS/CPT procedure code definition 51585 51555 NCCI NCCI HCPCS/CPT procedure code definition 51585 51565 NCCI NCCI HCPCS/CPT procedure code definition 51585 51570 NCCI 51585 51575 BCBST NCCI Misuse of Column 2 code with Column 1 code / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT procedure code definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 120 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51585 51580 NCCI 51585 51585 BCBST Code redundant to self/should not be reported more than once due to standard description 51585 51590 BCBST OB-GYN procedure -- standard subset procedure rationale. 51585 51701 NCCI Standards of medical / surgical practice 51585 51702 NCCI NCCI Refer to Specific Guidelines 51585 51703 NCCI 51585 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51585 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51585 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51585 58662 NCCI NCCI Most extensive procedures 51585 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 64416 NCCI NCCI Refer to Specific Guidelines 51585 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51585 90775 NCCI Standards of medical/surgical practice 51585 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51590 00910 NCCI NCCI Anesthesia included in surgical procedures 51590 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 38562 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 38770 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51590 44180 NCCI HCPCS/CPT separate procedure definition 51590 44680 BCBST 51590 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51590 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51590 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51590 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51590 49002 BCBST 51590 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51590 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51590 50650 NCCI HCPCS/CPT "separate procedure" definition 51590 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT procedure code definition Standards of medical/surgical practice OB-GYN procedure -- standard subset procedure rationale. NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 121 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51590 50800 NCCI NCCI Standards of medical / surgical practice 51590 50810 NCCI NCCI Standards of medical / surgical practice 51590 50820 NCCI NCCI Standards of medical / surgical practice 51590 50825 NCCI NCCI Standards of medical / surgical practice 51590 51040 BCBST 51590 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51590 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51590 51525 NCCI 51590 51550 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51555 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51565 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51570 NCCI 51590 51575 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51580 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51590 BCBST Code redundant to self/should not be reported more than once due to standard description 51590 51701 NCCI Standards of medical / surgical practice 51590 51702 NCCI NCCI Refer to Specific Guidelines 51590 51703 NCCI Standards of medical/surgical practice 51590 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51590 58662 NCCI NCCI Most extensive procedures 51590 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 64416 NCCI NCCI Refer to Specific Guidelines 51590 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51590 90775 NCCI Standards of medical/surgical practice 51590 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51595 00910 NCCI NCCI Anesthesia included in surgical procedures 51595 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 38571 NCCI NCCI Most extensive procedures 51595 38572 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 38770 NCCI NCCI Most extensive procedures OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 122 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51595 38780 BCBST NCCI Misuse of Column 2 code with Column 1 code / OB-GYN procedure -standard subset procedure rationale. 51595 44005 NCCI 51595 44130 NCCI NCCI HCPCS/CPT separate procedure definition 51595 44180 NCCI HCPCS/CPT separate procedure definition 51595 44680 BCBST 51595 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51595 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51595 44950 NCCI NCCI Standards of medical / surgical practice 51595 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51595 49002 BCBST 51595 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51595 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51595 50010 BCBST 51595 50650 NCCI HCPCS/CPT "separate procedure" definition 51595 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 50800 NCCI NCCI Standards of medical / surgical practice 51595 50810 NCCI NCCI Standards of medical / surgical practice 51595 50820 NCCI NCCI Standards of medical / surgical practice 51595 50825 NCCI NCCI Standards of medical / surgical practice 51595 51040 BCBST 51595 51045 NCCI 51595 51520 BCBST 51595 51525 NCCI 51595 51550 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51555 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51565 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51570 NCCI 51595 51575 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51580 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51585 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51590 NCCI 51595 51595 BCBST 51595 51701 NCCI Standards of medical / surgical practice 51595 51702 NCCI NCCI Refer to Specific Guidelines 51595 51703 NCCI Standards of medical/surgical practice 51595 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 123 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51595 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51595 53210 NCCI NCCI Standards of medical / surgical practice 51595 55842 NCCI Misuse of column 2 code with column 1 code 51595 55845 NCCI Misuse of column 2 code with column 1 code 51595 58200 NCCI Standards of medical/surgical practice 51595 58210 NCCI Standards of medical/surgical practice 51595 58662 NCCI NCCI Most extensive procedures 51595 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 64416 NCCI NCCI Refer to Specific Guidelines 51595 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51595 90775 NCCI Standards of medical/surgical practice 51595 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51596 00910 NCCI NCCI Anesthesia included in surgical procedures 51596 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51596 44180 NCCI 51596 44680 BCBST 51596 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51596 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51596 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51596 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51596 49002 BCBST 51596 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51596 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51596 50010 BCBST 51596 50650 NCCI HCPCS/CPT "separate procedure" definition 51596 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 50800 NCCI NCCI Standards of medical / surgical practice 51596 50810 NCCI NCCI Standards of medical / surgical practice 51596 50820 NCCI NCCI Standards of medical / surgical practice 51596 50825 NCCI NCCI Standards of medical / surgical practice 51596 51040 BCBST HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 124 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51596 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51596 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51596 51525 NCCI 51596 51550 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51555 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51565 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51570 NCCI 51596 51575 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51585 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51590 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51595 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51596 BCBST Code redundant to self/should not be reported more than once due to standard description 51596 51701 NCCI Standards of medical / surgical practice 51596 51702 NCCI NCCI Refer to Specific Guidelines 51596 51703 NCCI 51596 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51596 58662 NCCI NCCI Most extensive procedures 51596 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 64416 NCCI NCCI Refer to Specific Guidelines 51596 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51596 90775 NCCI Standards of medical/surgical practice 51596 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51597 00910 NCCI NCCI Anesthesia included in surgical procedures 51597 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 38780 BCBST 51597 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44140 NCCI NCCI Standards of medical / surgical practice 51597 44141 NCCI NCCI Standards of medical / surgical practice 51597 44143 NCCI NCCI Standards of medical / surgical practice 51597 44144 NCCI NCCI Standards of medical / surgical practice NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition Standards of medical/surgical practice OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 125 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51597 44145 NCCI NCCI Standards of medical / surgical practice 51597 44146 NCCI NCCI Standards of medical / surgical practice 51597 44147 NCCI NCCI Standards of medical / surgical practice 51597 44150 NCCI NCCI Standards of medical / surgical practice 51597 44151 NCCI NCCI Standards of medical / surgical practice 51597 44155 NCCI NCCI Standards of medical / surgical practice 51597 44156 NCCI NCCI Standards of medical / surgical practice 51597 44157 NCCI Most extensive procedure 51597 44158 NCCI Most extensive procedure 51597 44180 NCCI HCPCS/CPT separate procedure definition 51597 44188 NCCI Misuse of column 2 code with column 1 code 51597 44320 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44322 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44340 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44345 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44346 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44620 NCCI NCCI Standards of medical / surgical practice 51597 44625 NCCI NCCI Standards of medical / surgical practice 51597 44680 BCBST 51597 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51597 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51597 45110 NCCI NCCI Most extensive procedures 51597 45111 NCCI NCCI Most extensive procedures 51597 45112 NCCI NCCI Most extensive procedures 51597 45113 NCCI NCCI Most extensive procedures 51597 45114 NCCI NCCI Most extensive procedures 51597 45116 NCCI NCCI Most extensive procedures 51597 45119 NCCI NCCI Most extensive procedures 51597 45120 NCCI NCCI Most extensive procedures 51597 45121 NCCI NCCI Most extensive procedures 51597 45123 NCCI NCCI Most extensive procedures 51597 45130 NCCI NCCI Most extensive procedures 51597 45135 NCCI NCCI Most extensive procedures 51597 45160 NCCI NCCI Most extensive procedures 51597 45170 NCCI NCCI Most extensive procedures 51597 45190 NCCI NCCI Most extensive procedures 51597 45395 NCCI Most extensive procedure 51597 45397 NCCI Most extensive procedure OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 126 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51597 45505 NCCI NCCI Most extensive procedures 51597 45540 NCCI NCCI Most extensive procedures 51597 46080 NCCI NCCI HCPCS/CPT separate procedure definition 51597 46083 NCCI NCCI Most extensive procedures 51597 46200 NCCI NCCI Most extensive procedures 51597 46210 NCCI NCCI Most extensive procedures 51597 46220 NCCI NCCI HCPCS/CPT separate procedure definition 51597 46221 NCCI NCCI Most extensive procedures 51597 46230 NCCI NCCI Most extensive procedures 51597 46250 NCCI NCCI Most extensive procedures 51597 46255 NCCI NCCI Most extensive procedures 51597 46257 NCCI NCCI Most extensive procedures 51597 46258 NCCI NCCI Most extensive procedures 51597 46260 NCCI NCCI Most extensive procedures 51597 46261 NCCI NCCI Most extensive procedures 51597 46262 NCCI NCCI Most extensive procedures 51597 46270 NCCI NCCI Most extensive procedures 51597 46275 NCCI NCCI Most extensive procedures 51597 46280 NCCI NCCI Most extensive procedures 51597 46285 NCCI NCCI Most extensive procedures 51597 46600 NCCI NCCI HCPCS/CPT separate procedure definition 51597 46940 NCCI NCCI HCPCS/CPT separate procedure definition 51597 46942 NCCI NCCI HCPCS/CPT separate procedure definition 51597 46947 NCCI Most extensive procedure 51597 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51597 49002 BCBST 51597 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51597 49020 NCCI NCCI Most extensive procedures 51597 49040 NCCI NCCI Most extensive procedures 51597 49080 NCCI NCCI Standards of medical / surgical practice 51597 49203 NCCI Standards of medical/surgical practice 51597 49204 NCCI Standards of medical/surgical practice 51597 49205 NCCI Standards of medical/surgical practice 51597 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51597 49560 NCCI NCCI Standards of medical / surgical practice 51597 49561 NCCI NCCI Standards of medical / surgical practice 51597 49565 NCCI NCCI Standards of medical / surgical practice 51597 49566 NCCI NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 127 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51597 49570 NCCI NCCI HCPCS/CPT separate procedure definition 51597 49580 NCCI NCCI Standards of medical / surgical practice 51597 49582 NCCI NCCI Standards of medical / surgical practice 51597 49585 NCCI NCCI Standards of medical / surgical practice 51597 49587 NCCI NCCI Standards of medical / surgical practice 51597 50010 BCBST 51597 50650 NCCI HCPCS/CPT "separate procedure" definition 51597 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 50800 NCCI NCCI Standards of medical / surgical practice 51597 50810 NCCI NCCI Standards of medical / surgical practice 51597 50815 NCCI NCCI Standards of medical / surgical practice 51597 50820 NCCI NCCI Standards of medical / surgical practice 51597 51040 NCCI NCCI Standards of medical / surgical practice 51597 51045 NCCI NCCI HCPCS/CPT separate procedure definition 51597 51520 NCCI NCCI HCPCS/CPT separate procedure definition 51597 51525 NCCI NCCI HCPCS/CPT separate procedure definition 51597 51550 NCCI NCCI Most extensive procedures 51597 51555 NCCI NCCI Most extensive procedures 51597 51565 NCCI NCCI Most extensive procedures 51597 51570 NCCI NCCI HCPCS/CPT separate procedure definition 51597 51575 NCCI NCCI Most extensive procedures 51597 51580 NCCI NCCI Most extensive procedures 51597 51585 NCCI NCCI Most extensive procedures 51597 51590 NCCI NCCI Most extensive procedures 51597 51595 NCCI NCCI Most extensive procedures 51597 51596 NCCI 51597 51597 BCBST 51597 51701 NCCI NCCI Refer to Specific Guidelines 51597 51702 NCCI NCCI Refer to Specific Guidelines 51597 51703 NCCI 51597 51800 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 51865 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 57106 NCCI 51597 57410 NCCI Standards of medical/surgical practice 51597 57530 NCCI NCCI Most extensive procedures 51597 57531 NCCI NCCI Most extensive procedures 51597 57540 NCCI NCCI Most extensive procedures 51597 57545 NCCI NCCI Most extensive procedures OB-GYN procedure -- standard subset procedure rationale. NCCI Most extensive procedures OB-GYN procedure redundant to itself. NCCI Refer to Specific Guidelines NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 128 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51597 57550 NCCI NCCI Most extensive procedures 51597 57555 NCCI NCCI Most extensive procedures 51597 57556 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 58100 NCCI NCCI Most extensive procedures 51597 58120 NCCI NCCI Most extensive procedures 51597 58140 NCCI NCCI HCPCS/CPT separate procedure definition 51597 58145 NCCI NCCI HCPCS/CPT separate procedure definition 51597 58146 NCCI Most extensive procedures 51597 58150 NCCI NCCI Most extensive procedures 51597 58152 NCCI NCCI Most extensive procedures 51597 58180 NCCI NCCI Most extensive procedures 51597 58200 NCCI NCCI Most extensive procedures 51597 58210 NCCI NCCI Most extensive procedures 51597 58240 NCCI NCCI Mutually exclusive procedures 51597 58260 NCCI NCCI Most extensive procedures 51597 58262 NCCI NCCI Most extensive procedures 51597 58263 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 58267 NCCI NCCI Most extensive procedures 51597 58270 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 58275 NCCI NCCI Most extensive procedures 51597 58280 NCCI 51597 58285 BCBST 51597 58290 NCCI Most extensive procedures 51597 58291 NCCI Most extensive procedures 51597 58292 NCCI Misuse of Column 2 code with Column 1 code 51597 58293 NCCI Most extensive procedures 51597 58294 NCCI Misuse of Column 2 code with Column 1 code 51597 58541 NCCI Misuse of column 2 code with column 1 code 51597 58542 NCCI Misuse of column 2 code with column 1 code 51597 58543 NCCI Misuse of column 2 code with column 1 code 51597 58544 NCCI Misuse of column 2 code with column 1 code 51597 58548 NCCI Misuse of column 2 code with column 1 code 51597 58558 NCCI NCCI Most extensive procedures 51597 58570 NCCI Misuse of column 2 code with column 1 code 51597 58571 NCCI Misuse of column 2 code with column 1 code 51597 58572 NCCI Misuse of column 2 code with column 1 code 51597 58573 NCCI 51597 58600 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 58615 BCBST OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure -- standard subset procedure rationale. Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 129 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51597 58660 NCCI NCCI Sequential procedures 51597 58662 NCCI NCCI Most extensive procedures 51597 58700 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 58720 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 58940 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 58943 BCBST OB-GYN procedure -- standard subset procedure rationale. 51597 58950 NCCI Misuse of Column 2 code with Column 1 code 51597 58951 NCCI Misuse of Column 2 code with Column 1 code 51597 58952 NCCI Misuse of Column 2 code with Column 1 code 51597 58953 NCCI Misuse of Column 2 code with Column 1 code 51597 58954 NCCI Misuse of Column 2 code with Column 1 code 51597 58956 NCCI Misuse of column 2 code with column 1 code 51597 58957 NCCI Misuse of column 2 code with column 1 code 51597 58958 NCCI Misuse of column 2 code with column 1 code 51597 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 64416 NCCI NCCI Refer to Specific Guidelines 51597 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51597 90775 NCCI Standards of medical/surgical practice 51597 P9612 NCCI NCCI Standards of medical / surgical practice 51597 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51600 00910 NCCI NCCI Anesthesia included in surgical procedures 51600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 51600 BCBST 51600 51700 NCCI NCCI Standards of medical / surgical practice 51600 51701 NCCI NCCI Refer to Specific Guidelines 51600 51702 NCCI NCCI Refer to Specific Guidelines 51600 51703 NCCI NCCI Refer to Specific Guidelines 51600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 64416 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 130 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51600 76000 NCCI HCPCS/CPT coding manual instruction / guideline 51600 76001 NCCI HCPCS/CPT coding manual instruction / guideline 51600 90775 NCCI Standards of medical/surgical practice 51600 P9612 NCCI NCCI Standards of medical / surgical practice 51600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51605 00910 NCCI NCCI Anesthesia included in surgical procedures 51605 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 50715 NCCI 51605 51605 BCBST 51605 51700 NCCI NCCI Standards of medical / surgical practice 51605 51701 NCCI NCCI Refer to Specific Guidelines 51605 51702 NCCI NCCI Refer to Specific Guidelines 51605 51703 NCCI NCCI Refer to Specific Guidelines 51605 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 64416 NCCI NCCI Refer to Specific Guidelines 51605 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51605 90775 NCCI Standards of medical/surgical practice 51605 J2001 NCCI Misuse of column 2 code with column 1 code 51605 P9612 NCCI NCCI Standards of medical / surgical practice 51605 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51610 00910 NCCI NCCI Anesthesia included in surgical procedures 51610 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 51600 NCCI 51610 51610 BCBST 51610 51700 NCCI NCCI Standards of medical / surgical practice 51610 51701 NCCI NCCI Refer to Specific Guidelines NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI Most extensive procedures Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 131 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51610 51702 NCCI NCCI Refer to Specific Guidelines 51610 51703 NCCI Standards of medical / surgical practice 51610 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 64416 NCCI NCCI Refer to Specific Guidelines 51610 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51610 90775 NCCI Standards of medical/surgical practice 51610 J2001 NCCI Misuse of column 2 code with column 1 code 51610 P9612 NCCI NCCI Standards of medical / surgical practice 51610 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51700 00910 NCCI NCCI Anesthesia included in surgical procedures 51700 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 51700 BCBST OB-GYN procedure redundant to itself. 51700 51701 BCBST Edited code not allowed if used to report catheterization included in the listed procedure. 51700 51702 NCCI NCCI Refer to Specific Guidelines 51700 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 64416 NCCI NCCI Refer to Specific Guidelines 51700 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51700 90775 NCCI Standards of medical/surgical practice 51700 J2001 NCCI Misuse of column 2 code with column 1 code 51700 P9612 NCCI NCCI Standards of medical / surgical practice 51701 69990 NCCI Misuse of Column 2 code with Column 1 code 51701 90775 NCCI Standards of medical/surgical practice 51701 J2001 NCCI Misuse of column 2 code with column 1 code 51701 P9612 BCBST Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 132 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51701 P9615 NCCI Mutually exclusive procedures 51701 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51702 51701 NCCI Most extensive procedures 51702 51702 BCBST 51702 69990 NCCI 51702 90775 NCCI Standards of medical/surgical practice 51702 J2001 NCCI Misuse of column 2 code with column 1 code 51702 P9612 BCBST 51702 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51703 37202 NCCI Misuse of Column 2 code with Column 1 code 51703 51700 NCCI Standards of medical / surgical practice 51703 51701 NCCI Most extensive procedures 51703 51702 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 51703 51702 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 51703 51703 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 51703 53080 NCCI HCPCS/CPT separate procedure definition 51703 62318 NCCI Misuse of Column 2 code with Column 1 code 51703 62319 NCCI Misuse of Column 2 code with Column 1 code 51703 64415 NCCI Misuse of Column 2 code with Column 1 code 51703 64417 NCCI Misuse of Column 2 code with Column 1 code 51703 64450 NCCI Misuse of Column 2 code with Column 1 code 51703 64470 NCCI Misuse of Column 2 code with Column 1 code 51703 64475 NCCI Misuse of Column 2 code with Column 1 code 51703 69990 NCCI Misuse of Column 2 code with Column 1 code 51703 90775 NCCI Standards of medical/surgical practice 51703 J2001 NCCI Misuse of column 2 code with column 1 code 51703 P9612 BCBST 51703 S0020 CPT 51705 00910 NCCI NCCI Anesthesia included in surgical procedures 51705 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 51700 NCCI NCCI Standards of medical / surgical practice This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. Misuse of Column 2 code with Column 1 code Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 133 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51705 51701 NCCI Standards of medical / surgical practice 51705 51702 NCCI NCCI Refer to Specific Guidelines 51705 51703 NCCI Standards of medical/surgical practice 51705 51705 BCBST OB-GYN procedure redundant to itself. 51705 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 64416 NCCI NCCI Refer to Specific Guidelines 51705 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51705 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51705 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51705 77002 NCCI HCPCS/CPT coding manual instruction/guideline 51705 90775 NCCI Standards of medical/surgical practice 51705 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51710 00910 NCCI NCCI Anesthesia included in surgical procedures 51710 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 51701 NCCI Standards of medical / surgical practice 51710 51702 NCCI NCCI Refer to Specific Guidelines 51710 51703 NCCI Standards of medical/surgical practice 51710 51705 NCCI NCCI Most extensive procedures 51710 51710 BCBST 51710 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 64416 NCCI NCCI Refer to Specific Guidelines 51710 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51710 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51710 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51710 77002 NCCI HCPCS/CPT coding manual instruction/guideline OB-GYN procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 134 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51710 90775 NCCI Standards of medical/surgical practice 51710 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51715 00910 NCCI NCCI Anesthesia included in surgical procedures 51715 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 51701 NCCI NCCI Refer to Specific Guidelines 51715 51702 NCCI NCCI Refer to Specific Guidelines 51715 51703 NCCI 51715 51715 BCBST 51715 52000 NCCI NCCI HCPCS/CPT separate procedure definition 51715 52001 NCCI NCCI Standards of medical / surgical practice 51715 52005 NCCI NCCI Standards of medical / surgical practice 51715 52007 NCCI NCCI Standards of medical / surgical practice 51715 52010 NCCI NCCI Standards of medical / surgical practice 51715 52204 NCCI NCCI Standards of medical / surgical practice 51715 52214 NCCI NCCI Standards of medical / surgical practice 51715 52224 NCCI NCCI Standards of medical / surgical practice 51715 52281 NCCI NCCI Standards of medical / surgical practice 51715 52283 NCCI NCCI Standards of medical / surgical practice 51715 52285 NCCI NCCI Standards of medical / surgical practice 51715 52332 NCCI NCCI Standards of medical / surgical practice 51715 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 64416 NCCI NCCI Refer to Specific Guidelines 51715 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51715 90775 NCCI Standards of medical/surgical practice 51715 J2001 NCCI Misuse of column 2 code with column 1 code 51715 P9612 NCCI NCCI Standards of medical / surgical practice 51715 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51720 00910 NCCI NCCI Anesthesia included in surgical procedures 51720 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 135 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51720 51700 NCCI NCCI Standards of medical / surgical practice 51720 51701 NCCI NCCI Refer to Specific Guidelines 51720 51702 NCCI NCCI Refer to Specific Guidelines 51720 51703 NCCI NCCI Refer to Specific Guidelines 51720 51720 BCBST 51720 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 64416 NCCI NCCI Refer to Specific Guidelines 51720 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51720 90775 NCCI Standards of medical/surgical practice 51720 J2001 NCCI Misuse of column 2 code with column 1 code 51720 P9612 NCCI NCCI Standards of medical / surgical practice 51725 00910 NCCI NCCI Anesthesia included in surgical procedures 51725 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 51701 NCCI NCCI Refer to Specific Guidelines 51725 51702 NCCI NCCI Refer to Specific Guidelines 51725 51703 NCCI NCCI Refer to Specific Guidelines 51725 51725 BCBST Code redundant to self/should not be reported more than once due to standard description 51725 51725 BCBST Code redundant to self/should not be reported more than once due to standard description 51725 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 64416 NCCI NCCI Refer to Specific Guidelines 51725 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51725 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. 51725 90775 NCCI Standards of medical/surgical practice 51725 P9612 NCCI NCCI Standards of medical / surgical practice 51725 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 136 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51726 00910 NCCI NCCI Anesthesia included in surgical procedures 51726 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 51701 NCCI NCCI Refer to Specific Guidelines 51726 51702 NCCI NCCI Refer to Specific Guidelines 51726 51703 NCCI NCCI Refer to Specific Guidelines 51726 51725 NCCI NCCI Most extensive procedures 51726 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 64416 NCCI NCCI Refer to Specific Guidelines 51726 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51726 90775 NCCI Standards of medical/surgical practice 51726 P9612 NCCI NCCI Standards of medical / surgical practice 51726 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51736 00910 NCCI NCCI Anesthesia included in surgical procedures 51736 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 51701 NCCI NCCI Refer to Specific Guidelines 51736 51702 NCCI NCCI Refer to Specific Guidelines 51736 51703 NCCI NCCI Refer to Specific Guidelines 51736 51736 BCBST Code redundant to self/should not be reported more than once due to standard description 51736 51736 BCBST Code redundant to self/should not be reported more than once due to standard description 51736 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 64416 NCCI NCCI Refer to Specific Guidelines 51736 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51736 90775 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 137 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51736 P9612 NCCI NCCI Standards of medical / surgical practice 51736 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51741 00910 NCCI NCCI Anesthesia included in surgical procedures 51741 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 51701 NCCI NCCI Refer to Specific Guidelines 51741 51702 NCCI NCCI Refer to Specific Guidelines 51741 51703 NCCI Standards of medical/surgical practice 51741 51736 NCCI NCCI Most extensive procedures 51741 51741 BCBST Code redundant to self/should not be reported more than once due to standard description 51741 51741 BCBST Code redundant to self/should not be reported more than once due to standard description 51741 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 64416 NCCI NCCI Refer to Specific Guidelines 51741 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51741 90775 NCCI Standards of medical/surgical practice 51741 P9612 NCCI NCCI Standards of medical / surgical practice 51741 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51772 00910 NCCI NCCI Anesthesia included in surgical procedures 51772 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 51701 NCCI NCCI Refer to Specific Guidelines 51772 51702 NCCI NCCI Refer to Specific Guidelines 51772 51703 NCCI 51772 51772 BCBST Code redundant to self/should not be reported more than once due to standard description 51772 51772 BCBST Code redundant to self/should not be reported more than once due to standard description 51772 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 64416 NCCI NCCI Refer to Specific Guidelines 51772 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 138 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51772 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51772 90775 NCCI Standards of medical/surgical practice 51772 P9612 NCCI NCCI Standards of medical / surgical practice 51772 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51784 00910 NCCI NCCI Anesthesia included in surgical procedures 51784 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 51701 NCCI Standards of medical / surgical practice 51784 51703 NCCI Standards of medical/surgical practice 51784 51784 BCBST Code redundant to self/should not be reported more than once due to standard description 51784 51784 BCBST Code redundant to self/should not be reported more than once due to standard description 51784 51785 NCCI NCCI Most extensive procedures 51784 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 64416 NCCI NCCI Refer to Specific Guidelines 51784 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51784 90775 NCCI Standards of medical/surgical practice 51784 95870 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 00910 NCCI NCCI Anesthesia included in surgical procedures 51785 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 51701 NCCI NCCI Refer to Specific Guidelines 51785 51702 NCCI NCCI Refer to Specific Guidelines 51785 51703 NCCI NCCI Refer to Specific Guidelines 51785 51785 BCBST Code redundant to self/should not be reported more than once due to standard description 51785 51785 BCBST Code redundant to self/should not be reported more than once due to standard description 51785 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 139 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51785 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 64416 NCCI NCCI Refer to Specific Guidelines 51785 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51785 90775 NCCI Standards of medical/surgical practice 51785 95870 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51785 P9612 NCCI NCCI Standards of medical / surgical practice 51785 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51792 00910 NCCI NCCI Anesthesia included in surgical procedures 51792 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 51701 NCCI NCCI Refer to Specific Guidelines 51792 51702 NCCI NCCI Refer to Specific Guidelines 51792 51703 NCCI 51792 51792 BCBST Code redundant to self/should not be reported more than once due to standard description 51792 51792 BCBST Code redundant to self/should not be reported more than once due to standard description 51792 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 64416 NCCI NCCI Refer to Specific Guidelines 51792 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51792 90775 NCCI Standards of medical/surgical practice 51792 95870 NCCI NCCI Standards of medical / surgical practice 51792 P9612 NCCI NCCI Standards of medical / surgical practice 51792 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51795 00910 NCCI NCCI Anesthesia included in surgical procedures 51795 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 51701 NCCI NCCI Refer to Specific Guidelines 51795 51702 NCCI NCCI Refer to Specific Guidelines NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 140 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51795 51703 NCCI 51795 51795 BCBST Code redundant to self/should not be reported more than once due to standard description 51795 51795 BCBST Code redundant to self/should not be reported more than once due to standard description 51795 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 64416 NCCI NCCI Refer to Specific Guidelines 51795 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51795 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines 51795 90775 NCCI Standards of medical/surgical practice 51795 P9612 NCCI NCCI Standards of medical / surgical practice 51795 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51797 51797 BCBST Code redundant to self/should not be reported more than once due to standard description 51797 51797 BCBST Code redundant to self/should not be reported more than once due to standard description 51797 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51798 37202 NCCI Misuse of Column 2 code with Column 1 code 51798 51798 NCCI This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 51798 62318 NCCI Misuse of Column 2 code with Column 1 code 51798 62319 NCCI Misuse of Column 2 code with Column 1 code 51798 64415 NCCI Misuse of Column 2 code with Column 1 code 51798 64417 NCCI Misuse of Column 2 code with Column 1 code 51798 64450 NCCI Misuse of Column 2 code with Column 1 code 51798 64470 NCCI Misuse of Column 2 code with Column 1 code 51798 64475 NCCI Misuse of Column 2 code with Column 1 code 51798 69990 NCCI Misuse of Column 2 code with Column 1 code 51798 99211 NCCI Standards of medical / surgical practice 51798 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51800 00910 NCCI NCCI Anesthesia included in surgical procedures 51800 37202 NCCI 51800 44680 BCBST OB-GYN procedure -- standard subset procedure rationale. 51800 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 141 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51800 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 51800 49000 BCBST NCCI HCPCS/CPT separate procedure definition / OB-GYN procedure -- standard subset procedure rationale. 51800 49002 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 51800 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 51800 50715 NCCI 51800 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51800 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51800 51550 NCCI NCCI Standards of medical / surgical practice 51800 51701 NCCI Standards of medical / surgical practice 51800 51702 NCCI NCCI Refer to Specific Guidelines 51800 51703 NCCI Standards of medical/surgical practice 51800 51800 BCBST OB-GYN procedure redundant to itself. 51800 51860 NCCI NCCI Standards of medical / surgical practice 51800 51865 NCCI NCCI Standards of medical / surgical practice 51800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 64416 NCCI NCCI Refer to Specific Guidelines 51800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51800 90775 NCCI Standards of medical/surgical practice 51800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51820 00910 NCCI NCCI Anesthesia included in surgical procedures 51820 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51820 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51820 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51820 49002 NCCI NCCI Standards of medical / surgical practice 51820 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51820 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 51701 NCCI Standards of medical / surgical practice 51820 51702 NCCI NCCI Refer to Specific Guidelines 51820 51703 NCCI Standards of medical/surgical practice 51820 51800 NCCI NCCI Standards of medical / surgical practice NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 142 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51820 51820 BCBST Code redundant to self/should not be reported more than once due to standard description 51820 51860 NCCI 51820 51865 NCCI NCCI Standards of medical / surgical practice 51820 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 64416 NCCI NCCI Refer to Specific Guidelines 51820 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51820 NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice 69990 NCCI 51820 90775 NCCI Standards of medical/surgical practice 51820 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51840 00910 NCCI NCCI Anesthesia included in surgical procedures 51840 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 44850 BCBST OB-GYN procedure -- standard subset procedure rationale. 51840 44950 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. 51840 49000 NCCI 51840 49002 BCBST 51840 50715 NCCI 51840 51040 NCCI 51840 51520 BCBST 51840 51701 NCCI Standards of medical / surgical practice 51840 51702 NCCI NCCI Refer to Specific Guidelines 51840 51703 NCCI Standards of medical/surgical practice 51840 51840 BCBST OB-GYN procedure redundant to itself. 51840 52000 NCCI NCCI HCPCS/CPT separate procedure definition 51840 52001 NCCI NCCI Standards of medical / surgical practice 51840 52005 NCCI NCCI Standards of medical / surgical practice 51840 53660 NCCI NCCI Standards of medical / surgical practice 51840 53661 NCCI NCCI Standards of medical / surgical practice 51840 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 64416 NCCI NCCI Refer to Specific Guidelines 51840 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 143 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51840 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51840 90775 NCCI Standards of medical/surgical practice 51840 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51841 00910 NCCI NCCI Anesthesia included in surgical procedures 51841 37202 NCCI 51841 44850 BCBST 51841 44950 NCCI 51841 44955 BCBST 51841 49000 NCCI 51841 49002 BCBST NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. 51841 49255 BCBST OB-GYN procedure -- standard subset procedure rationale. 51841 50010 BCBST OB-GYN procedure -- standard subset procedure rationale. 51841 50715 NCCI 51841 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51841 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51841 51701 NCCI Standards of medical / surgical practice 51841 51702 NCCI NCCI Refer to Specific Guidelines 51841 51703 NCCI Standards of medical/surgical practice 51841 51840 NCCI 51841 51841 BCBST OB-GYN procedure redundant to itself. 51841 51860 BCBST OB-GYN procedure -- standard subset procedure rationale. 51841 52000 NCCI 51841 52001 NCCI NCCI Standards of medical / surgical practice 51841 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 64416 NCCI NCCI Refer to Specific Guidelines 51841 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51841 90775 NCCI Standards of medical/surgical practice 51841 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT coding manual instruction / guideline OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Misuse of Column 2 code with Column 1 code NCCI Most extensive procedures NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 144 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51845 00910 NCCI NCCI Anesthesia included in surgical procedures 51845 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51845 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51845 44950 BCBST 51845 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51845 49002 NCCI NCCI Standards of medical / surgical practice 51845 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51845 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51845 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 51040 NCCI NCCI Standards of medical / surgical practice 51845 51701 NCCI Standards of medical / surgical practice 51845 51702 NCCI NCCI Refer to Specific Guidelines 51845 51703 NCCI Standards of medical/surgical practice 51845 51840 NCCI NCCI Mutually exclusive procedures 51845 51841 NCCI NCCI Mutually exclusive procedures 51845 51845 BCBST 51845 52000 NCCI NCCI HCPCS/CPT separate procedure definition 51845 52001 NCCI NCCI Standards of medical / surgical practice 51845 52005 NCCI NCCI Standards of medical / surgical practice 51845 52281 NCCI NCCI Standards of medical / surgical practice 51845 52332 NCCI NCCI Standards of medical / surgical practice 51845 53660 NCCI NCCI Standards of medical / surgical practice 51845 53661 NCCI NCCI Standards of medical / surgical practice 51845 57250 NCCI NCCI Standards of medical / surgical practice 51845 57265 NCCI NCCI Standards of medical / surgical practice 51845 57289 NCCI NCCI Standards of medical / surgical practice 51845 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 64416 NCCI NCCI Refer to Specific Guidelines 51845 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51845 90775 NCCI Standards of medical/surgical practice 51845 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package NCCI HCPCS/CPT coding manual instruction / guideline / OB-GYN procedure -standard subset procedure rationale. OB-GYN procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 145 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51860 00910 NCCI NCCI Anesthesia included in surgical procedures 51860 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51860 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51860 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51860 49002 NCCI NCCI Standards of medical / surgical practice 51860 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51860 49255 NCCI 51860 50010 BCBST 51860 50715 NCCI 51860 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51860 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51860 51701 NCCI Standards of medical / surgical practice 51860 51702 NCCI NCCI Refer to Specific Guidelines 51860 51703 NCCI Standards of medical/surgical practice 51860 51860 BCBST OB-GYN procedure redundant to itself. 51860 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 64416 NCCI NCCI Refer to Specific Guidelines 51860 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51860 90775 NCCI Standards of medical/surgical practice 51860 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51865 00910 NCCI NCCI Anesthesia included in surgical procedures 51865 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51865 44180 NCCI 51865 44680 BCBST 51865 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51865 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51865 49000 NCCI 51865 49002 BCBST 51865 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51865 49255 NCCI NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 146 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51865 50010 BCBST OB-GYN procedure -- standard subset procedure rationale. 51865 50715 NCCI 51865 51040 NCCI 51865 51520 BCBST 51865 51701 NCCI Standards of medical / surgical practice 51865 51702 NCCI NCCI Refer to Specific Guidelines 51865 51703 NCCI Standards of medical/surgical practice 51865 51860 NCCI 51865 51865 BCBST 51865 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 64416 NCCI NCCI Refer to Specific Guidelines 51865 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51865 90775 NCCI Standards of medical/surgical practice 51865 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51880 00910 NCCI NCCI Anesthesia included in surgical procedures 51880 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51880 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 51701 NCCI Standards of medical / surgical practice 51880 51702 NCCI NCCI Refer to Specific Guidelines 51880 51703 NCCI Standards of medical/surgical practice 51880 51880 BCBST 51880 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 64416 NCCI NCCI Refer to Specific Guidelines 51880 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51880 90775 NCCI Standards of medical/surgical practice NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice OB-GYN procedure -- standard subset procedure rationale. NCCI Most extensive procedures OB-GYN procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 147 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51880 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51900 00910 NCCI NCCI Anesthesia included in surgical procedures 51900 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51900 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51900 49000 NCCI 51900 49002 BCBST 51900 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51900 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51900 50010 BCBST 51900 50715 NCCI 51900 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 51701 NCCI Standards of medical / surgical practice 51900 51702 NCCI NCCI Refer to Specific Guidelines 51900 51703 NCCI Standards of medical/surgical practice 51900 51860 NCCI NCCI Standards of medical / surgical practice 51900 51865 NCCI NCCI Standards of medical / surgical practice 51900 51880 NCCI NCCI HCPCS/CPT separate procedure definition 51900 51900 BCBST OB-GYN procedure redundant to itself. 51900 57000 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57100 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57105 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57106 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57200 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57210 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57270 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57320 BCBST OB-GYN redundant procedure. 51900 57330 BCBST OB-GYN redundant procedure. 51900 57400 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57410 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57452 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57454 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 57460 BCBST OB-GYN procedure -- standard subset procedure rationale. 51900 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 64416 NCCI NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 148 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51900 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51900 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 51900 90775 NCCI Standards of medical/surgical practice 51900 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51920 00910 NCCI NCCI Anesthesia included in surgical procedures 51920 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51920 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51920 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51920 49002 BCBST 51920 49010 NCCI 51920 49255 NCCI 51920 50010 BCBST 51920 50715 NCCI 51920 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51920 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51920 51701 NCCI Standards of medical / surgical practice 51920 51702 NCCI NCCI Refer to Specific Guidelines 51920 51703 NCCI Standards of medical/surgical practice 51920 51860 NCCI NCCI Standards of medical / surgical practice 51920 51865 NCCI NCCI Standards of medical / surgical practice 51920 51880 NCCI NCCI HCPCS/CPT separate procedure definition 51920 51920 BCBST OB-GYN procedure redundant to itself. 51920 58145 BCBST OB-GYN procedure -- standard subset procedure rationale. 51920 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 64416 NCCI NCCI Refer to Specific Guidelines 51920 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51920 90775 NCCI Standards of medical/surgical practice NCCI Standards of medical / surgical practice / OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 149 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51920 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51925 00910 NCCI NCCI Anesthesia included in surgical procedures 51925 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51925 44180 NCCI HCPCS/CPT separate procedure definition 51925 44680 BCBST 51925 44850 NCCI 51925 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51925 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51925 49002 NCCI NCCI Standards of medical / surgical practice 51925 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51925 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51925 50010 BCBST 51925 50715 NCCI 51925 51040 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 51520 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 51701 NCCI Standards of medical / surgical practice 51925 51702 NCCI NCCI Refer to Specific Guidelines 51925 51703 NCCI Standards of medical/surgical practice 51925 51860 NCCI NCCI Standards of medical / surgical practice 51925 51865 NCCI NCCI Standards of medical / surgical practice 51925 51880 NCCI NCCI HCPCS/CPT separate procedure definition 51925 51920 NCCI NCCI HCPCS/CPT procedure code definition 51925 51925 BCBST Code redundant to self/should not be reported more than once due to standard description 51925 58140 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 58145 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 58150 NCCI NCCI HCPCS/CPT procedure code definition 51925 58152 NCCI NCCI HCPCS/CPT procedure code definition 51925 58180 NCCI NCCI HCPCS/CPT procedure code definition 51925 58260 NCCI NCCI HCPCS/CPT procedure code definition 51925 58262 NCCI NCCI Standards of medical / surgical practice 51925 58263 NCCI NCCI Standards of medical / surgical practice 51925 58267 NCCI NCCI HCPCS/CPT procedure code definition 51925 58270 NCCI NCCI HCPCS/CPT procedure code definition 51925 58275 NCCI NCCI HCPCS/CPT procedure code definition 51925 58280 NCCI NCCI HCPCS/CPT procedure code definition 51925 58290 NCCI HCPCS/CPT procedure code definition 51925 58291 NCCI Standards of medical / surgical practice OB-GYN procedure -- standard subset procedure rationale. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 150 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51925 58292 NCCI Standards of medical / surgical practice 51925 58293 NCCI HCPCS/CPT procedure code definition 51925 58294 NCCI 51925 58700 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 58720 BCBST OB-GYN procedure -- standard subset procedure rationale. 51925 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 64416 NCCI NCCI Refer to Specific Guidelines 51925 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51925 NCCI Misuse of Column 2 code with Column 1 code HCPCS/CPT procedure code definition 69990 NCCI 51925 90775 NCCI Standards of medical/surgical practice 51925 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51940 00910 NCCI NCCI Anesthesia included in surgical procedures 51940 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51940 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51940 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51940 49002 NCCI NCCI Standards of medical / surgical practice 51940 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51940 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51940 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 51701 NCCI Standards of medical / surgical practice 51940 51702 NCCI NCCI Refer to Specific Guidelines 51940 51703 NCCI Standards of medical/surgical practice 51940 51880 NCCI NCCI HCPCS/CPT separate procedure definition 51940 51940 BCBST 51940 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 64416 NCCI NCCI Refer to Specific Guidelines 51940 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 151 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51940 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51940 90775 NCCI Standards of medical/surgical practice 51940 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51960 00910 NCCI NCCI Anesthesia included in surgical procedures 51960 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 44005 NCCI NCCI HCPCS/CPT separate procedure definition 51960 44180 NCCI HCPCS/CPT separate procedure definition 51960 44661 NCCI NCCI Standards of medical / surgical practice 51960 44820 NCCI NCCI HCPCS/CPT separate procedure definition 51960 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51960 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51960 45800 NCCI NCCI Standards of medical / surgical practice 51960 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51960 49002 NCCI NCCI Standards of medical / surgical practice 51960 49010 NCCI NCCI HCPCS/CPT separate procedure definition 51960 49255 NCCI NCCI HCPCS/CPT separate procedure definition 51960 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 51701 NCCI Standards of medical / surgical practice 51960 51702 NCCI NCCI Refer to Specific Guidelines 51960 51703 NCCI Standards of medical/surgical practice 51960 51960 BCBST 51960 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 64416 NCCI NCCI Refer to Specific Guidelines 51960 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51960 NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. 69990 NCCI 51960 90775 NCCI Standards of medical/surgical practice 51960 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51980 00910 NCCI NCCI Anesthesia included in surgical procedures 51980 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 44850 NCCI NCCI HCPCS/CPT separate procedure definition 51980 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51980 49000 NCCI NCCI HCPCS/CPT separate procedure definition 51980 49002 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 152 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51980 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 51701 NCCI Standards of medical / surgical practice 51980 51702 NCCI NCCI Refer to Specific Guidelines 51980 51703 NCCI Standards of medical/surgical practice 51980 51880 NCCI NCCI HCPCS/CPT separate procedure definition 51980 51980 BCBST 51980 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 64416 NCCI NCCI Refer to Specific Guidelines 51980 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51980 90775 NCCI Standards of medical/surgical practice 51980 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51990 00910 NCCI NCCI Anesthesia included in surgical procedures 51990 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 43653 NCCI CPT "separate procedure" definition 51990 44005 NCCI Misuse of column 2 code with column 1 code 51990 44180 NCCI HCPCS/CPT separate procedure definition 51990 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51990 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 51701 NCCI Standards of medical / surgical practice 51990 51702 NCCI NCCI Refer to Specific Guidelines 51990 51703 NCCI Standards of medical/surgical practice 51990 51990 BCBST 51990 57285 NCCI CPT manual and CMS coding manual instructions 51990 58660 NCCI NCCI HCPCS/CPT separate procedure definition 51990 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 64416 NCCI NCCI Refer to Specific Guidelines 51990 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 153 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 51990 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51990 90775 NCCI Standards of medical/surgical practice 51990 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 51992 00910 NCCI NCCI Anesthesia included in surgical procedures 51992 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 43653 NCCI CPT "separate procedure" definition 51992 44005 NCCI Misuse of column 2 code with column 1 code 51992 44180 NCCI HCPCS/CPT separate procedure definition 51992 49320 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 51992 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 51701 NCCI Standards of medical / surgical practice 51992 51702 NCCI NCCI Refer to Specific Guidelines 51992 51703 NCCI 51992 51992 BCBST 51992 58660 NCCI NCCI HCPCS/CPT separate procedure definition 51992 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 64416 NCCI NCCI Refer to Specific Guidelines 51992 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 51992 90775 NCCI Standards of medical/surgical practice 51992 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52000 00910 NCCI NCCI Anesthesia included in surgical procedures 52000 00916 NCCI NCCI Anesthesia included in surgical procedures 52000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 51701 NCCI NCCI Refer to Specific Guidelines 52000 51702 NCCI NCCI Refer to Specific Guidelines 52000 51703 NCCI NCCI Refer to Specific Guidelines 52000 52000 BCBST 52000 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline Standards of medical/surgical practice Code redundant to self/should not be reported more than once due to standard description Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 154 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52000 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52000 57410 NCCI Standards of medical/surgical practice 52000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 64416 NCCI NCCI Refer to Specific Guidelines 52000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52000 90775 NCCI Standards of medical/surgical practice 52000 J2001 NCCI Misuse of column 2 code with column 1 code 52000 P9612 NCCI NCCI Standards of medical / surgical practice 52000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52001 00910 NCCI NCCI Anesthesia included in surgical procedures 52001 00916 NCCI NCCI Anesthesia included in surgical procedures 52001 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 51700 BCBST 52001 51701 NCCI NCCI Refer to Specific Guidelines 52001 51702 NCCI NCCI Refer to Specific Guidelines 52001 51703 NCCI NCCI Refer to Specific Guidelines 52001 52000 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / A diagnostic cystourethroscopy is considered a component of a definitive cystourethroscopic procedure and therefore should not be reported for services occurring at the same session as the listed procedure. 52001 52000 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited code is a component of the listed code when performed as part of the listed procedure. 52001 52000 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / A diagnostic cystourethroscopy is considered a component of a definitive cystourethroscopic procedure and therefore should not be reported for services occurring at the same session as the listed procedure. 52001 52000 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited code is a component of the listed code when performed as part of the listed procedure. 52001 52001 BCBST Procedure redundant to itself. 52001 53600 NCCI NCCI Standards of medical / surgical practice 52001 53601 NCCI NCCI Standards of medical / surgical practice NCCI HCPCS/CPT procedure code definition / Edited code not allowed if used to report incidental bladder irrigation at the time of the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 155 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52001 53605 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 52001 53620 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 52001 53621 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 52001 53660 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 52001 53661 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 52001 57410 NCCI Standards of medical/surgical practice 52001 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 64416 NCCI NCCI Refer to Specific Guidelines 52001 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52001 69990 BCBST 52001 90775 NCCI 52001 P9612 BCBST 52001 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52005 00910 NCCI NCCI Anesthesia included in surgical procedures 52005 00916 NCCI NCCI Anesthesia included in surgical procedures 52005 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 50684 NCCI HCPCS/CPT procedure code definition 52005 51600 NCCI NCCI HCPCS/CPT procedure code definition 52005 51610 NCCI NCCI HCPCS/CPT procedure code definition 52005 51700 NCCI NCCI HCPCS/CPT procedure code definition 52005 51701 NCCI NCCI Refer to Specific Guidelines 52005 51702 NCCI NCCI Refer to Specific Guidelines 52005 51703 NCCI NCCI Refer to Specific Guidelines 52005 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52005 52001 NCCI NCCI Standards of medical / surgical practice 52005 52265 NCCI NCCI Mutually exclusive procedures 52005 52315 NCCI NCCI Standards of medical / surgical practice 52005 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 156 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52005 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52005 57410 NCCI Standards of medical/surgical practice 52005 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 64416 NCCI NCCI Refer to Specific Guidelines 52005 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52005 90775 NCCI Standards of medical/surgical practice 52005 P9612 NCCI NCCI Standards of medical / surgical practice 52005 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52007 00910 NCCI NCCI Anesthesia included in surgical procedures 52007 00916 NCCI NCCI Anesthesia included in surgical procedures 52007 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 50684 NCCI HCPCS/CPT procedure code definition 52007 51700 NCCI NCCI Standards of medical / surgical practice 52007 51701 NCCI NCCI Refer to Specific Guidelines 52007 51702 NCCI NCCI Refer to Specific Guidelines 52007 51703 NCCI NCCI Refer to Specific Guidelines 52007 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52007 52001 NCCI NCCI Standards of medical / surgical practice 52007 52005 NCCI NCCI HCPCS/CPT procedure code definition 52007 52204 NCCI HCPCS/CPT procedure code definition 52007 52310 NCCI NCCI Standards of medical / surgical practice 52007 52315 NCCI NCCI Standards of medical / surgical practice 52007 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 157 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52007 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52007 57410 NCCI Standards of medical/surgical practice 52007 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 64416 NCCI NCCI Refer to Specific Guidelines 52007 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52007 90775 NCCI Standards of medical/surgical practice 52007 P9612 NCCI NCCI Standards of medical / surgical practice 52007 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52010 00910 NCCI NCCI Anesthesia included in surgical procedures 52010 00916 NCCI NCCI Anesthesia included in surgical procedures 52010 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 51701 NCCI NCCI Refer to Specific Guidelines 52010 51702 NCCI NCCI Refer to Specific Guidelines 52010 51703 NCCI NCCI Refer to Specific Guidelines 52010 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52010 52001 NCCI NCCI Standards of medical / surgical practice 52010 52250 NCCI NCCI Mutually exclusive procedures 52010 52310 NCCI NCCI Standards of medical / surgical practice 52010 52315 NCCI NCCI Standards of medical / surgical practice 52010 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52010 57410 NCCI Standards of medical/surgical practice 52010 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 158 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52010 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 64416 NCCI NCCI Refer to Specific Guidelines 52010 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52010 90775 NCCI Standards of medical/surgical practice 52010 J2001 NCCI Misuse of column 2 code with column 1 code 52010 P9612 NCCI NCCI Standards of medical / surgical practice 52010 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52204 00910 NCCI NCCI Anesthesia included in surgical procedures 52204 00916 NCCI NCCI Anesthesia included in surgical procedures 52204 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 51700 NCCI NCCI Standards of medical / surgical practice 52204 51701 NCCI NCCI Refer to Specific Guidelines 52204 51702 NCCI NCCI Refer to Specific Guidelines 52204 51703 NCCI NCCI Refer to Specific Guidelines 52204 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52204 52001 NCCI NCCI Standards of medical / surgical practice 52204 52005 NCCI Most extensive procedures 52204 52204 BCBST 52204 52310 NCCI NCCI Standards of medical / surgical practice 52204 52315 NCCI NCCI Standards of medical / surgical practice 52204 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52204 57410 NCCI Standards of medical/surgical practice 52204 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 64416 NCCI NCCI Refer to Specific Guidelines 52204 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 159 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52204 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52204 90775 NCCI Standards of medical/surgical practice 52204 P9612 NCCI NCCI Standards of medical / surgical practice 52204 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52214 00910 NCCI NCCI Anesthesia included in surgical procedures 52214 00912 NCCI NCCI Anesthesia included in surgical procedures 52214 00916 NCCI NCCI Anesthesia included in surgical procedures 52214 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 51701 NCCI NCCI Refer to Specific Guidelines 52214 51702 NCCI NCCI Refer to Specific Guidelines 52214 51703 NCCI NCCI Refer to Specific Guidelines 52214 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52214 52001 NCCI NCCI Standards of medical / surgical practice 52214 52005 NCCI NCCI Most extensive procedures 52214 52204 NCCI NCCI Most extensive procedures 52214 52214 BCBST 52214 52224 NCCI NCCI Most extensive procedures 52214 52250 NCCI NCCI Mutually exclusive procedures 52214 52260 NCCI NCCI Most extensive procedures 52214 52265 NCCI NCCI Most extensive procedures 52214 52310 NCCI NCCI Standards of medical / surgical practice 52214 52315 NCCI NCCI Standards of medical / surgical practice 52214 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52214 57410 NCCI Standards of medical/surgical practice 52214 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 64416 NCCI NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 160 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52214 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52214 90775 NCCI Standards of medical/surgical practice 52214 J2001 NCCI Misuse of column 2 code with column 1 code 52214 P9612 NCCI NCCI Standards of medical / surgical practice 52214 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52224 00910 NCCI NCCI Anesthesia included in surgical procedures 52224 00912 NCCI NCCI Anesthesia included in surgical procedures 52224 00916 NCCI NCCI Anesthesia included in surgical procedures 52224 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 51701 NCCI NCCI Refer to Specific Guidelines 52224 51702 NCCI NCCI Refer to Specific Guidelines 52224 51703 NCCI NCCI Refer to Specific Guidelines 52224 51720 NCCI NCCI Standards of medical / surgical practice 52224 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52224 52001 NCCI NCCI Standards of medical / surgical practice 52224 52005 NCCI Most extensive procedures 52224 52204 NCCI NCCI HCPCS/CPT procedure code definition 52224 52224 BCBST 52224 52260 NCCI NCCI Most extensive procedures 52224 52310 NCCI NCCI Standards of medical / surgical practice 52224 52315 NCCI NCCI Standards of medical / surgical practice 52224 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52224 57410 NCCI Standards of medical/surgical practice 52224 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 64416 NCCI NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 161 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52224 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52224 90775 NCCI Standards of medical/surgical practice 52224 J2001 NCCI Misuse of column 2 code with column 1 code 52224 P9612 NCCI NCCI Standards of medical / surgical practice 52224 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52234 00910 NCCI NCCI Anesthesia included in surgical procedures 52234 00912 NCCI NCCI Anesthesia included in surgical procedures 52234 00916 NCCI NCCI Anesthesia included in surgical procedures 52234 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 51700 NCCI NCCI Standards of medical / surgical practice 52234 51701 NCCI NCCI Refer to Specific Guidelines 52234 51702 NCCI NCCI Refer to Specific Guidelines 52234 51703 NCCI NCCI Refer to Specific Guidelines 52234 51720 NCCI NCCI Standards of medical / surgical practice 52234 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52234 52001 NCCI NCCI Standards of medical / surgical practice 52234 52005 NCCI NCCI Most extensive procedures 52234 52204 NCCI NCCI Most extensive procedures 52234 52224 NCCI NCCI Most extensive procedures 52234 52234 BCBST 52234 52276 NCCI NCCI Most extensive procedures 52234 52310 NCCI NCCI Standards of medical / surgical practice 52234 52315 NCCI NCCI Standards of medical / surgical practice 52234 52332 NCCI NCCI Standards of medical / surgical practice 52234 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52234 57410 NCCI Standards of medical/surgical practice 52234 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 162 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52234 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 64416 NCCI NCCI Refer to Specific Guidelines 52234 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52234 90775 NCCI Standards of medical/surgical practice 52234 P9612 NCCI NCCI Standards of medical / surgical practice 52234 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52235 00910 NCCI NCCI Anesthesia included in surgical procedures 52235 00912 NCCI NCCI Anesthesia included in surgical procedures 52235 00916 NCCI NCCI Anesthesia included in surgical procedures 52235 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 51700 NCCI NCCI Standards of medical / surgical practice 52235 51701 NCCI NCCI Refer to Specific Guidelines 52235 51702 NCCI NCCI Refer to Specific Guidelines 52235 51703 NCCI NCCI Refer to Specific Guidelines 52235 51720 NCCI NCCI Standards of medical / surgical practice 52235 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52235 52001 NCCI NCCI Standards of medical / surgical practice 52235 52005 NCCI NCCI Most extensive procedures 52235 52204 NCCI NCCI Most extensive procedures 52235 52214 NCCI NCCI Most extensive procedures 52235 52224 NCCI NCCI Most extensive procedures 52235 52234 NCCI NCCI Most extensive procedures 52235 52235 BCBST 52235 52276 NCCI NCCI Standards of medical / surgical practice 52235 52281 NCCI NCCI Standards of medical / surgical practice 52235 52310 NCCI NCCI Standards of medical / surgical practice 52235 52315 NCCI NCCI Standards of medical / surgical practice 52235 52332 NCCI NCCI Standards of medical / surgical practice 52235 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 163 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52235 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52235 57410 NCCI Standards of medical/surgical practice 52235 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 64416 NCCI NCCI Refer to Specific Guidelines 52235 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52235 90775 NCCI Standards of medical/surgical practice 52235 P9612 NCCI NCCI Standards of medical / surgical practice 52235 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52240 00910 NCCI NCCI Anesthesia included in surgical procedures 52240 00912 NCCI NCCI Anesthesia included in surgical procedures 52240 00916 NCCI NCCI Anesthesia included in surgical procedures 52240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 51700 NCCI NCCI Standards of medical / surgical practice 52240 51701 NCCI NCCI Refer to Specific Guidelines 52240 51702 NCCI NCCI Refer to Specific Guidelines 52240 51703 NCCI NCCI Refer to Specific Guidelines 52240 51720 NCCI NCCI Standards of medical / surgical practice 52240 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52240 52001 NCCI NCCI Standards of medical / surgical practice 52240 52005 NCCI NCCI Most extensive procedures 52240 52204 NCCI NCCI Most extensive procedures 52240 52214 NCCI NCCI Most extensive procedures 52240 52224 NCCI NCCI Most extensive procedures 52240 52234 NCCI NCCI Most extensive procedures 52240 52235 NCCI 52240 52240 BCBST 52240 52276 NCCI NCCI Most extensive procedures 52240 52281 NCCI NCCI Most extensive procedures 52240 52310 NCCI NCCI Standards of medical / surgical practice 52240 52315 NCCI NCCI Standards of medical / surgical practice NCCI Most extensive procedures Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 164 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52240 52317 NCCI NCCI Standards of medical / surgical practice 52240 52332 NCCI NCCI Standards of medical / surgical practice 52240 52354 BCBST NCCI Standards of medical / surgical practice 52240 52400 NCCI NCCI Standards of medical / surgical practice 52240 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52240 57410 NCCI Standards of medical/surgical practice 52240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 64416 NCCI NCCI Refer to Specific Guidelines 52240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52240 90775 NCCI Standards of medical/surgical practice 52240 P9612 NCCI NCCI Standards of medical / surgical practice 52240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52250 00910 NCCI NCCI Anesthesia included in surgical procedures 52250 00916 NCCI NCCI Anesthesia included in surgical procedures 52250 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 51701 NCCI NCCI Refer to Specific Guidelines 52250 51702 NCCI NCCI Refer to Specific Guidelines 52250 51703 NCCI NCCI Refer to Specific Guidelines 52250 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52250 52001 NCCI NCCI Standards of medical / surgical practice 52250 52204 NCCI NCCI HCPCS/CPT procedure code definition 52250 52224 NCCI NCCI HCPCS/CPT procedure code definition 52250 52234 NCCI NCCI Mutually exclusive procedures 52250 52235 NCCI NCCI Mutually exclusive procedures 52250 52240 NCCI NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 165 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52250 52250 BCBST Code redundant to self/should not be reported more than once due to standard description 52250 52310 NCCI NCCI Standards of medical / surgical practice 52250 52315 NCCI NCCI Standards of medical / surgical practice 52250 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52250 57410 NCCI Standards of medical/surgical practice 52250 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 64416 NCCI NCCI Refer to Specific Guidelines 52250 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52250 90775 NCCI Standards of medical/surgical practice 52250 P9612 NCCI NCCI Standards of medical / surgical practice 52250 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52260 00910 NCCI NCCI Anesthesia included in surgical procedures 52260 00916 NCCI NCCI Anesthesia included in surgical procedures 52260 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 51700 BCBST 52260 51701 NCCI NCCI Refer to Specific Guidelines 52260 51702 NCCI NCCI Refer to Specific Guidelines 52260 51703 NCCI 52260 51705 BCBST Standard subset procedure rationale. 52260 51710 BCBST Standard subset procedure rationale. 52260 52000 NCCI 52260 52001 NCCI NCCI Standards of medical / surgical practice 52260 52005 NCCI NCCI Most extensive procedures Because bladder is distended with irrigation solution as part of the comprehensive procedure; the simple bladder irrigation is considered integral to the primary procedure NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 166 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52260 52204 NCCI 52260 52260 BCBST 52260 52281 NCCI Standards of medical/surgical practice 52260 52310 NCCI NCCI Standards of medical / surgical practice 52260 52315 NCCI NCCI Standards of medical / surgical practice 52260 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52260 57410 NCCI Standards of medical/surgical practice 52260 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 64416 NCCI NCCI Refer to Specific Guidelines 52260 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52260 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description 52260 90775 NCCI Standards of medical/surgical practice 52260 P9612 NCCI NCCI Standards of medical / surgical practice 52260 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52265 00910 NCCI NCCI Anesthesia included in surgical procedures 52265 00916 NCCI NCCI Anesthesia included in surgical procedures 52265 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 51701 NCCI NCCI Refer to Specific Guidelines 52265 51702 NCCI NCCI Refer to Specific Guidelines 52265 51703 NCCI NCCI Refer to Specific Guidelines 52265 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52265 52001 NCCI NCCI Standards of medical / surgical practice 52265 52204 NCCI NCCI Standards of medical / surgical practice 52265 52260 NCCI NCCI Mutually exclusive procedures 52265 52265 BCBST Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 167 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52265 52310 NCCI NCCI Standards of medical / surgical practice 52265 52315 NCCI NCCI Standards of medical / surgical practice 52265 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52265 57410 NCCI Standards of medical/surgical practice 52265 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 64416 NCCI NCCI Refer to Specific Guidelines 52265 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52265 90775 NCCI Standards of medical/surgical practice 52265 J2001 NCCI Misuse of column 2 code with column 1 code 52265 P9612 NCCI NCCI Standards of medical / surgical practice 52265 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52270 00910 NCCI NCCI Anesthesia included in surgical procedures 52270 00916 NCCI NCCI Anesthesia included in surgical procedures 52270 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 51701 NCCI NCCI Refer to Specific Guidelines 52270 51702 NCCI NCCI Refer to Specific Guidelines 52270 51703 NCCI NCCI Refer to Specific Guidelines 52270 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52270 52001 NCCI NCCI Standards of medical / surgical practice 52270 52270 BCBST 52270 52310 NCCI NCCI Standards of medical / surgical practice 52270 52315 NCCI NCCI Standards of medical / surgical practice 52270 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 168 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52270 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52270 57410 NCCI Standards of medical/surgical practice 52270 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 64416 NCCI NCCI Refer to Specific Guidelines 52270 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52270 90775 NCCI Standards of medical/surgical practice 52270 J2001 NCCI Misuse of column 2 code with column 1 code 52270 P9612 NCCI NCCI Standards of medical / surgical practice 52270 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52275 00910 NCCI NCCI Anesthesia included in surgical procedures 52275 00916 NCCI NCCI Anesthesia included in surgical procedures 52275 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 51701 NCCI NCCI Refer to Specific Guidelines 52275 51702 NCCI NCCI Refer to Specific Guidelines 52275 51703 NCCI NCCI Refer to Specific Guidelines 52275 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52275 52001 NCCI NCCI Standards of medical / surgical practice 52275 52270 NCCI 52275 52275 BCBST 52275 52276 NCCI NCCI HCPCS/CPT procedure code definition 52275 52310 NCCI NCCI Standards of medical / surgical practice 52275 52315 NCCI NCCI Standards of medical / surgical practice 52275 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline NCCI Gender-specific procedures formerly Designation of Sex Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 169 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52275 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52275 57410 NCCI Standards of medical/surgical practice 52275 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 64416 NCCI NCCI Refer to Specific Guidelines 52275 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52275 90775 NCCI Standards of medical/surgical practice 52275 J2001 NCCI Misuse of column 2 code with column 1 code 52275 P9612 NCCI NCCI Standards of medical / surgical practice 52275 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52276 00910 NCCI NCCI Anesthesia included in surgical procedures 52276 00916 NCCI NCCI Anesthesia included in surgical procedures 52276 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 51102 NCCI Standards of medical/surgical practice 52276 51700 NCCI NCCI Standards of medical / surgical practice 52276 51701 NCCI NCCI Refer to Specific Guidelines 52276 51702 NCCI NCCI Refer to Specific Guidelines 52276 51703 NCCI NCCI Refer to Specific Guidelines 52276 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52276 52001 NCCI NCCI Standards of medical / surgical practice 52276 52204 NCCI NCCI Standards of medical / surgical practice 52276 52270 NCCI 52276 52276 BCBST 52276 52310 NCCI NCCI Standards of medical / surgical practice 52276 52315 NCCI NCCI Standards of medical / surgical practice 52276 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 170 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52276 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52276 57410 NCCI Standards of medical/surgical practice 52276 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 64416 NCCI NCCI Refer to Specific Guidelines 52276 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52276 90775 NCCI Standards of medical/surgical practice 52276 J2001 NCCI Misuse of column 2 code with column 1 code 52276 P9612 NCCI NCCI Standards of medical / surgical practice 52276 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52277 00910 NCCI NCCI Anesthesia included in surgical procedures 52277 00916 NCCI NCCI Anesthesia included in surgical procedures 52277 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 51701 NCCI NCCI Refer to Specific Guidelines 52277 51702 NCCI NCCI Refer to Specific Guidelines 52277 51703 NCCI NCCI Refer to Specific Guidelines 52277 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52277 52001 NCCI NCCI Standards of medical / surgical practice 52277 52277 BCBST 52277 52301 NCCI NCCI Most extensive procedures 52277 52310 NCCI NCCI Standards of medical / surgical practice 52277 52315 NCCI NCCI Standards of medical / surgical practice 52277 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52277 57410 NCCI Standards of medical/surgical practice 52277 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 171 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52277 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 64416 NCCI NCCI Refer to Specific Guidelines 52277 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52277 90775 NCCI Standards of medical/surgical practice 52277 P9612 NCCI NCCI Standards of medical / surgical practice 52277 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52281 00910 NCCI NCCI Anesthesia included in surgical procedures 52281 00916 NCCI NCCI Anesthesia included in surgical procedures 52281 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 51600 NCCI NCCI Standards of medical / surgical practice 52281 51605 NCCI NCCI HCPCS/CPT procedure code definition 52281 51610 NCCI NCCI HCPCS/CPT procedure code definition 52281 51700 NCCI NCCI Standards of medical / surgical practice 52281 51701 NCCI NCCI Refer to Specific Guidelines 52281 51702 NCCI NCCI Refer to Specific Guidelines 52281 51703 NCCI NCCI Refer to Specific Guidelines 52281 51720 NCCI NCCI Standards of medical / surgical practice 52281 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52281 52005 NCCI Most extensive procedures 52281 52204 NCCI 52281 52281 BCBST 52281 52283 NCCI NCCI Standards of medical / surgical practice 52281 53020 NCCI NCCI Standards of medical / surgical practice 52281 53025 NCCI NCCI Standards of medical / surgical practice 52281 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52281 57410 NCCI Standards of medical/surgical practice 52281 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 172 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52281 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 64416 NCCI NCCI Refer to Specific Guidelines 52281 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52281 90775 NCCI Standards of medical/surgical practice 52281 P9612 NCCI NCCI Standards of medical / surgical practice 52281 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52282 00910 NCCI NCCI Anesthesia included in surgical procedures 52282 00916 NCCI NCCI Anesthesia included in surgical procedures 52282 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 51701 NCCI NCCI Refer to Specific Guidelines 52282 51702 NCCI NCCI Refer to Specific Guidelines 52282 51703 NCCI NCCI Refer to Specific Guidelines 52282 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52282 52001 NCCI NCCI Standards of medical / surgical practice 52282 52281 NCCI NCCI Refer to Specific Guidelines 52282 52282 BCBST 52282 52310 NCCI NCCI Standards of medical / surgical practice 52282 52315 NCCI NCCI Standards of medical / surgical practice 52282 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52282 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52282 57410 NCCI Standards of medical/surgical practice 52282 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 64416 NCCI NCCI Refer to Specific Guidelines 52282 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 173 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52282 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52282 90775 NCCI Standards of medical/surgical practice 52282 J2001 NCCI Misuse of column 2 code with column 1 code 52282 P9612 NCCI NCCI Standards of medical / surgical practice 52282 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52283 00910 NCCI NCCI Anesthesia included in surgical procedures 52283 00916 NCCI NCCI Anesthesia included in surgical procedures 52283 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 51701 NCCI NCCI Refer to Specific Guidelines 52283 51702 NCCI NCCI Refer to Specific Guidelines 52283 51703 NCCI NCCI Refer to Specific Guidelines 52283 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52283 52001 NCCI NCCI Standards of medical / surgical practice 52283 52283 BCBST 52283 52310 NCCI NCCI Standards of medical / surgical practice 52283 52315 NCCI NCCI Standards of medical / surgical practice 52283 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52283 57410 NCCI Standards of medical/surgical practice 52283 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 64416 NCCI NCCI Refer to Specific Guidelines 52283 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52283 90775 NCCI Standards of medical/surgical practice Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 174 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52283 J2001 NCCI Misuse of column 2 code with column 1 code 52283 P9612 NCCI NCCI Standards of medical / surgical practice 52283 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52285 00910 NCCI NCCI Anesthesia included in surgical procedures 52285 00916 NCCI NCCI Anesthesia included in surgical procedures 52285 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 51701 NCCI NCCI Refer to Specific Guidelines 52285 51702 NCCI NCCI Refer to Specific Guidelines 52285 51703 NCCI NCCI Refer to Specific Guidelines 52285 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52285 52001 NCCI NCCI Standards of medical / surgical practice 52285 52005 NCCI Most extensive procedures 52285 52214 NCCI NCCI Standards of medical / surgical practice 52285 52270 NCCI NCCI Refer to Specific Guidelines 52285 52270 NCCI NCCI Standards of medical / surgical practice 52285 52276 NCCI NCCI Standards of medical / surgical practice 52285 52281 NCCI NCCI Refer to Specific Guidelines 52285 52281 NCCI NCCI Standards of medical / surgical practice 52285 52285 BCBST 52285 52310 NCCI NCCI Standards of medical / surgical practice 52285 52315 NCCI NCCI Standards of medical / surgical practice 52285 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52285 57410 NCCI Standards of medical/surgical practice 52285 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 64416 NCCI NCCI Refer to Specific Guidelines 52285 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 175 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52285 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52285 90775 NCCI Standards of medical/surgical practice 52285 J2001 NCCI Misuse of column 2 code with column 1 code 52285 P9612 NCCI NCCI Standards of medical / surgical practice 52285 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52290 00910 NCCI NCCI Anesthesia included in surgical procedures 52290 00916 NCCI NCCI Anesthesia included in surgical procedures 52290 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 51701 NCCI NCCI Refer to Specific Guidelines 52290 51702 NCCI NCCI Refer to Specific Guidelines 52290 51703 NCCI NCCI Refer to Specific Guidelines 52290 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52290 52001 NCCI 52290 52290 BCBST 52290 52310 NCCI NCCI Standards of medical / surgical practice 52290 52315 NCCI NCCI Standards of medical / surgical practice 52290 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52290 57410 NCCI Standards of medical/surgical practice 52290 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 64416 NCCI NCCI Refer to Specific Guidelines 52290 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52290 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice Procedure redundant to itself. 52290 90775 NCCI Standards of medical/surgical practice 52290 P9612 NCCI NCCI Standards of medical / surgical practice 52290 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52300 00910 NCCI NCCI Anesthesia included in surgical procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 176 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52300 00916 NCCI NCCI Anesthesia included in surgical procedures 52300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 51701 NCCI NCCI Refer to Specific Guidelines 52300 51702 NCCI NCCI Refer to Specific Guidelines 52300 51703 NCCI NCCI Refer to Specific Guidelines 52300 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52300 52001 NCCI NCCI Standards of medical / surgical practice 52300 52290 NCCI 52300 52300 BCBST 52300 52310 NCCI NCCI Standards of medical / surgical practice 52300 52315 NCCI NCCI Standards of medical / surgical practice 52300 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52300 57410 NCCI Standards of medical/surgical practice 52300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 64416 NCCI NCCI Refer to Specific Guidelines 52300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52300 90775 NCCI Standards of medical/surgical practice 52300 P9612 NCCI NCCI Standards of medical / surgical practice 52300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52301 00910 NCCI NCCI Anesthesia included in surgical procedures 52301 00916 NCCI NCCI Anesthesia included in surgical procedures 52301 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 51701 NCCI NCCI Refer to Specific Guidelines 52301 51702 NCCI NCCI Refer to Specific Guidelines 52301 51703 NCCI NCCI Refer to Specific Guidelines NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 177 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52301 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52301 52001 NCCI NCCI Standards of medical / surgical practice 52301 52204 NCCI NCCI Most extensive procedures 52301 52270 NCCI NCCI Most extensive procedures 52301 52275 NCCI NCCI Most extensive procedures 52301 52276 NCCI NCCI Most extensive procedures 52301 52281 NCCI NCCI Most extensive procedures 52301 52290 NCCI NCCI Most extensive procedures 52301 52300 NCCI NCCI Most extensive procedures 52301 52305 NCCI NCCI Most extensive procedures 52301 52310 NCCI NCCI Standards of medical / surgical practice 52301 52315 NCCI NCCI Standards of medical / surgical practice 52301 52332 NCCI NCCI Most extensive procedures 52301 53000 NCCI NCCI Most extensive procedures 52301 53010 NCCI NCCI Most extensive procedures 52301 53020 NCCI NCCI Most extensive procedures 52301 53200 NCCI NCCI Most extensive procedures 52301 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52301 57410 NCCI Standards of medical/surgical practice 52301 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 64416 NCCI NCCI Refer to Specific Guidelines 52301 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52301 90775 NCCI Standards of medical/surgical practice 52301 P9612 NCCI NCCI Standards of medical / surgical practice 52301 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 178 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52305 00910 NCCI NCCI Anesthesia included in surgical procedures 52305 00916 NCCI NCCI Anesthesia included in surgical procedures 52305 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 51701 NCCI NCCI Refer to Specific Guidelines 52305 51702 NCCI NCCI Refer to Specific Guidelines 52305 51703 NCCI NCCI Refer to Specific Guidelines 52305 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52305 52001 NCCI 52305 52305 BCBST 52305 52310 NCCI NCCI Standards of medical / surgical practice 52305 52315 NCCI NCCI Standards of medical / surgical practice 52305 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52305 57410 NCCI Standards of medical/surgical practice 52305 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 64416 NCCI NCCI Refer to Specific Guidelines 52305 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52305 90775 NCCI Standards of medical/surgical practice 52305 P9612 NCCI NCCI Standards of medical / surgical practice 52305 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52310 00910 NCCI NCCI Anesthesia included in surgical procedures 52310 00916 NCCI NCCI Anesthesia included in surgical procedures 52310 00918 NCCI NCCI Anesthesia included in surgical procedures 52310 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 51700 NCCI NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 179 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52310 51701 NCCI NCCI Refer to Specific Guidelines 52310 51702 NCCI NCCI Refer to Specific Guidelines 52310 51703 NCCI NCCI Refer to Specific Guidelines 52310 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52310 52001 NCCI NCCI Standards of medical / surgical practice 52310 52310 BCBST 52310 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52310 57410 NCCI Standards of medical/surgical practice 52310 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 64416 NCCI NCCI Refer to Specific Guidelines 52310 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52310 90775 NCCI Standards of medical/surgical practice Code redundant to self/should not be reported more than once due to standard description 52310 J2001 NCCI Misuse of column 2 code with column 1 code 52310 P9612 NCCI NCCI Standards of medical / surgical practice 52310 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52315 00910 NCCI NCCI Anesthesia included in surgical procedures 52315 00916 NCCI NCCI Anesthesia included in surgical procedures 52315 00918 NCCI NCCI Anesthesia included in surgical procedures 52315 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 51701 NCCI NCCI Refer to Specific Guidelines 52315 51702 NCCI NCCI Refer to Specific Guidelines 52315 51703 NCCI NCCI Refer to Specific Guidelines 52315 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52315 52001 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 180 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52315 52310 NCCI 52315 52315 BCBST 52315 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52315 57410 NCCI Standards of medical/surgical practice 52315 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 64416 NCCI NCCI Refer to Specific Guidelines 52315 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52315 90775 NCCI Standards of medical/surgical practice Most extensive procedure Code redundant to self/should not be reported more than once due to standard description 52315 J2001 NCCI Misuse of column 2 code with column 1 code 52315 P9612 NCCI NCCI Standards of medical / surgical practice 52315 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52317 00910 NCCI NCCI Anesthesia included in surgical procedures 52317 00916 NCCI NCCI Anesthesia included in surgical procedures 52317 00918 NCCI NCCI Anesthesia included in surgical procedures 52317 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 51701 NCCI NCCI Refer to Specific Guidelines 52317 51702 NCCI NCCI Refer to Specific Guidelines 52317 51703 NCCI NCCI Refer to Specific Guidelines 52317 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52317 52204 NCCI NCCI Standards of medical / surgical practice 52317 52276 NCCI NCCI Standards of medical / surgical practice 52317 52310 NCCI NCCI Standards of medical / surgical practice 52317 52315 NCCI NCCI Standards of medical / surgical practice 52317 52317 BCBST Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 181 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52317 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52317 57410 NCCI Standards of medical/surgical practice 52317 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 64416 NCCI NCCI Refer to Specific Guidelines 52317 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52317 90775 NCCI Standards of medical/surgical practice 52317 J2001 NCCI Misuse of column 2 code with column 1 code 52317 P9612 NCCI NCCI Standards of medical / surgical practice 52317 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52318 00910 NCCI NCCI Anesthesia included in surgical procedures 52318 00916 NCCI NCCI Anesthesia included in surgical procedures 52318 00918 NCCI NCCI Anesthesia included in surgical procedures 52318 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 51701 NCCI NCCI Refer to Specific Guidelines 52318 51702 NCCI NCCI Refer to Specific Guidelines 52318 51703 NCCI NCCI Refer to Specific Guidelines 52318 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52318 52005 NCCI Misuse of Column 2 code with Column 1 code 52318 52204 NCCI NCCI Standards of medical / surgical practice 52318 52310 NCCI NCCI Standards of medical / surgical practice 52318 52315 NCCI NCCI Standards of medical / surgical practice 52318 52317 NCCI 52318 52318 BCBST 52318 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline NCCI Most extensive procedures Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 182 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52318 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52318 57410 NCCI Standards of medical/surgical practice 52318 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 64416 NCCI NCCI Refer to Specific Guidelines 52318 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52318 90775 NCCI Standards of medical/surgical practice 52318 P9612 NCCI NCCI Standards of medical / surgical practice 52318 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52320 00910 NCCI NCCI Anesthesia included in surgical procedures 52320 00916 NCCI NCCI Anesthesia included in surgical procedures 52320 00918 NCCI NCCI Anesthesia included in surgical procedures 52320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 50945 NCCI NCCI Most extensive procedures 52320 51701 NCCI NCCI Refer to Specific Guidelines 52320 51702 NCCI NCCI Refer to Specific Guidelines 52320 51703 NCCI NCCI Refer to Specific Guidelines 52320 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52320 52001 NCCI NCCI Standards of medical / surgical practice 52320 52005 NCCI NCCI HCPCS/CPT procedure code definition 52320 52007 NCCI Standards of medical/surgical practice 52320 52204 NCCI NCCI HCPCS/CPT procedure code definition 52320 52310 NCCI NCCI Standards of medical / surgical practice 52320 52315 NCCI NCCI Standards of medical / surgical practice 52320 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 183 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52320 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52320 57410 NCCI Standards of medical/surgical practice 52320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 64416 NCCI NCCI Refer to Specific Guidelines 52320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52320 90775 NCCI Standards of medical/surgical practice 52320 P9612 NCCI NCCI Standards of medical / surgical practice 52320 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52325 00910 NCCI NCCI Anesthesia included in surgical procedures 52325 00916 NCCI NCCI Anesthesia included in surgical procedures 52325 00918 NCCI NCCI Anesthesia included in surgical procedures 52325 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 50945 NCCI NCCI Most extensive procedures 52325 51701 NCCI NCCI Refer to Specific Guidelines 52325 51702 NCCI NCCI Refer to Specific Guidelines 52325 51703 NCCI NCCI Refer to Specific Guidelines 52325 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52325 52001 NCCI NCCI Standards of medical / surgical practice 52325 52005 NCCI NCCI Refer to Specific Guidelines 52325 52007 NCCI Standards of medical/surgical practice 52325 52310 NCCI NCCI Standards of medical / surgical practice 52325 52315 NCCI NCCI Standards of medical / surgical practice 52325 52317 NCCI NCCI Standards of medical / surgical practice 52325 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 184 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52325 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52325 57410 NCCI Standards of medical/surgical practice 52325 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 64416 NCCI NCCI Refer to Specific Guidelines 52325 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52325 90775 NCCI Standards of medical/surgical practice 52325 P9612 NCCI NCCI Standards of medical / surgical practice 52325 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52327 00910 NCCI NCCI Anesthesia included in surgical procedures 52327 00916 NCCI NCCI Anesthesia included in surgical procedures 52327 00918 NCCI NCCI Anesthesia included in surgical procedures 52327 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 51701 NCCI NCCI Refer to Specific Guidelines 52327 51702 NCCI NCCI Refer to Specific Guidelines 52327 51703 NCCI NCCI Refer to Specific Guidelines 52327 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52327 52001 NCCI NCCI Standards of medical / surgical practice 52327 52005 NCCI NCCI Refer to Specific Guidelines 52327 52007 NCCI Standards of medical/surgical practice 52327 52310 NCCI NCCI Standards of medical / surgical practice 52327 52315 NCCI NCCI Standards of medical / surgical practice 52327 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 185 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52327 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52327 57410 NCCI Standards of medical/surgical practice 52327 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 64416 NCCI NCCI Refer to Specific Guidelines 52327 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52327 90775 NCCI Standards of medical/surgical practice 52327 P9612 NCCI NCCI Standards of medical / surgical practice 52327 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52330 00910 NCCI NCCI Anesthesia included in surgical procedures 52330 00916 NCCI NCCI Anesthesia included in surgical procedures 52330 00918 NCCI NCCI Anesthesia included in surgical procedures 52330 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 51701 NCCI NCCI Refer to Specific Guidelines 52330 51702 NCCI NCCI Refer to Specific Guidelines 52330 51703 NCCI NCCI Refer to Specific Guidelines 52330 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52330 52001 NCCI NCCI Standards of medical / surgical practice 52330 52005 NCCI NCCI Refer to Specific Guidelines 52330 52007 NCCI Standards of medical/surgical practice 52330 52310 NCCI NCCI Standards of medical / surgical practice 52330 52315 NCCI NCCI Standards of medical / surgical practice 52330 52320 NCCI Mutually exclusive procedures 52330 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52330 57410 NCCI Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 186 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52330 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 64416 NCCI NCCI Refer to Specific Guidelines 52330 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52330 90775 NCCI Standards of medical/surgical practice 52330 J2001 NCCI Misuse of column 2 code with column 1 code 52330 P9612 NCCI NCCI Standards of medical / surgical practice 52330 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52332 00910 NCCI NCCI Anesthesia included in surgical procedures 52332 00916 NCCI NCCI Anesthesia included in surgical procedures 52332 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 50387 NCCI Misuse of column 2 code with column 1 code 52332 50394 NCCI NCCI Standards of medical / surgical practice 52332 50684 NCCI NCCI Standards of medical / surgical practice 52332 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 51700 NCCI NCCI Standards of medical / surgical practice 52332 51701 NCCI NCCI Refer to Specific Guidelines 52332 51702 NCCI NCCI Refer to Specific Guidelines 52332 51703 NCCI NCCI Refer to Specific Guidelines 52332 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52332 52001 NCCI NCCI Standards of medical / surgical practice 52332 52005 NCCI NCCI Standards of medical / surgical practice 52332 52007 NCCI NCCI Standards of medical / surgical practice 52332 52204 NCCI NCCI Standards of medical / surgical practice 52332 52310 NCCI NCCI Standards of medical / surgical practice 52332 52315 NCCI NCCI Standards of medical / surgical practice 52332 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 187 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52332 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52332 57410 NCCI Standards of medical/surgical practice 52332 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 64416 NCCI NCCI Refer to Specific Guidelines 52332 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52332 90775 NCCI Standards of medical/surgical practice 52332 J2001 NCCI Misuse of column 2 code with column 1 code 52332 P9612 NCCI NCCI Standards of medical / surgical practice 52332 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52334 00910 NCCI NCCI Anesthesia included in surgical procedures 52334 00916 NCCI NCCI Anesthesia included in surgical procedures 52334 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 51701 NCCI NCCI Refer to Specific Guidelines 52334 51702 NCCI NCCI Refer to Specific Guidelines 52334 51703 NCCI NCCI Refer to Specific Guidelines 52334 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52334 52001 NCCI NCCI Standards of medical / surgical practice 52334 52007 NCCI Standards of medical/surgical practice 52334 52310 NCCI NCCI Standards of medical / surgical practice 52334 52315 NCCI NCCI Standards of medical / surgical practice 52334 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52334 57410 NCCI Standards of medical/surgical practice 52334 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 188 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52334 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 64416 NCCI NCCI Refer to Specific Guidelines 52334 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52334 90775 NCCI Standards of medical/surgical practice 52334 P9612 NCCI NCCI Standards of medical / surgical practice 52334 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52341 00910 NCCI NCCI Anesthesia included in surgical procedures 52341 00916 NCCI NCCI Anesthesia included in surgical procedures 52341 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 50953 NCCI NCCI Mutually exclusive procedures 52341 50972 NCCI NCCI Mutually exclusive procedures 52341 51700 BCBST 52341 51701 NCCI NCCI Refer to Specific Guidelines 52341 51702 NCCI NCCI Refer to Specific Guidelines 52341 51703 NCCI 52341 52000 BCBST 52341 52001 NCCI 52341 52005 BCBST 52341 52007 NCCI Standards of medical/surgical practice 52341 52204 NCCI NCCI Standards of medical / surgical practice 52341 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 52351 NCCI 52341 53020 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. NCCI HCPCS/CPT coding manual instruction / guideline NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 189 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52341 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52341 57410 NCCI Standards of medical/surgical practice 52341 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 64416 NCCI NCCI Refer to Specific Guidelines 52341 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52341 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 52341 90775 NCCI 52341 P9612 BCBST 52341 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52342 00910 NCCI NCCI Anesthesia included in surgical procedures 52342 00916 NCCI NCCI Anesthesia included in surgical procedures 52342 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 50953 NCCI NCCI Mutually exclusive procedures 52342 50972 NCCI NCCI Mutually exclusive procedures 52342 51700 BCBST 52342 51701 NCCI NCCI Refer to Specific Guidelines 52342 51702 NCCI NCCI Refer to Specific Guidelines Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. The edited procedure involves only incidental additional work when performed with the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 190 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52342 51703 NCCI 52342 52000 BCBST 52342 52001 NCCI 52342 52005 BCBST 52342 52007 NCCI 52342 52204 NCCI 52342 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 52341 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 52342 52351 NCCI 52342 53020 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52342 57410 NCCI Standards of medical/surgical practice 52342 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. Standards of medical/surgical practice NCCI Standards of medical / surgical practice NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 191 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52342 64416 NCCI NCCI Refer to Specific Guidelines 52342 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52342 69990 BCBST 52342 90775 NCCI 52342 P9612 BCBST 52342 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52343 00910 NCCI NCCI Anesthesia included in surgical procedures 52343 00916 NCCI NCCI Anesthesia included in surgical procedures 52343 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 50953 NCCI NCCI Mutually exclusive procedures 52343 50972 NCCI NCCI Mutually exclusive procedures 52343 51700 BCBST 52343 51701 NCCI NCCI Refer to Specific Guidelines 52343 51702 NCCI NCCI Refer to Specific Guidelines 52343 51703 NCCI NCCI Refer to Specific Guidelines 52343 52000 BCBST 52343 52001 NCCI 52343 52005 BCBST 52343 52007 NCCI Standards of medical/surgical practice 52343 52204 NCCI NCCI Standards of medical / surgical practice 52343 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52341 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 192 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52343 52342 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 52351 NCCI 52343 53020 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52343 57410 NCCI Standards of medical/surgical practice 52343 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 64416 NCCI NCCI Refer to Specific Guidelines 52343 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52343 69990 BCBST 52343 90775 NCCI 52343 P9612 BCBST 52343 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52344 00910 NCCI NCCI Anesthesia included in surgical procedures 52344 00916 NCCI NCCI Anesthesia included in surgical procedures 52344 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 50953 NCCI NCCI Mutually exclusive procedures NCCI HCPCS/CPT coding manual instruction / guideline Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 193 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52344 50972 NCCI 52344 51700 BCBST 52344 51701 NCCI NCCI Refer to Specific Guidelines 52344 51702 NCCI NCCI Refer to Specific Guidelines 52344 51703 NCCI NCCI Refer to Specific Guidelines 52344 52000 BCBST 52344 52001 NCCI 52344 52005 BCBST 52344 52007 NCCI Standards of medical/surgical practice 52344 52204 NCCI NCCI Standards of medical / surgical practice 52344 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52341 BCBST NCCI Most extensive procedures / This code is a component of the listed code when performed during the same session. 52351 and 52341 rebundle to 52344. 52344 52342 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52343 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 52351 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited code is a component of the listed code when performed during the same session. 52351 and code 52341 rebundle to 52344. 52344 52354 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53020 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI Mutually exclusive procedures The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 194 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52344 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52344 57410 NCCI Standards of medical/surgical practice 52344 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 64416 NCCI NCCI Refer to Specific Guidelines 52344 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52344 64475 NCCI 52344 69990 BCBST 52344 90775 NCCI 52344 P9612 BCBST 52344 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52345 00910 NCCI NCCI Anesthesia included in surgical procedures 52345 00916 NCCI NCCI Anesthesia included in surgical procedures 52345 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 50953 NCCI NCCI Mutually exclusive procedures 52345 50972 NCCI NCCI Mutually exclusive procedures 52345 51700 BCBST 52345 51701 NCCI NCCI Refer to Specific Guidelines 52345 51702 NCCI NCCI Refer to Specific Guidelines 52345 51703 NCCI NCCI Refer to Specific Guidelines 52345 52000 BCBST 52345 52001 NCCI 52345 52005 BCBST 52345 52007 NCCI Standards of medical/surgical practice 52345 52204 NCCI NCCI Standards of medical / surgical practice NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 195 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52345 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52341 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52342 BCBST NCCI Most extensive procedures / This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 52345 52343 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 52351 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited code is a component of the listed code when performed during the same session. 52351 and code 52342 rebundle to 52345. 52345 52354 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53020 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52345 57410 NCCI Standards of medical/surgical practice 52345 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 64416 NCCI NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 196 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52345 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52345 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 52345 90775 NCCI 52345 P9612 BCBST 52345 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52346 00910 NCCI NCCI Anesthesia included in surgical procedures 52346 00916 NCCI NCCI Anesthesia included in surgical procedures 52346 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 50715 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 50953 NCCI NCCI Mutually exclusive procedures 52346 50972 NCCI 52346 51700 BCBST 52346 51701 NCCI NCCI Refer to Specific Guidelines 52346 51702 NCCI NCCI Refer to Specific Guidelines 52346 51703 NCCI 52346 52000 BCBST 52346 52001 NCCI 52346 52005 BCBST 52346 52007 NCCI 52346 52204 NCCI 52346 52270 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52275 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52283 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52290 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52310 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52315 BCBST NCCI Standards of medical / surgical practice / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52341 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. NCCI Mutually exclusive procedures The edited procedure involves only incidental additional work when performed with the listed procedure. NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. Standards of medical/surgical practice NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 197 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52346 52342 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 52343 BCBST NCCI Most extensive procedures / This code is a component of the listed code when performed during the same session. 52351 and 52343 rebundle to 52346. 52346 52351 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited code is a component of the listed code when performed during the same session. 52351 and code 52343 rebundle to 52346. 52346 52354 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53020 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53025 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53600 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53601 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53605 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53620 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53621 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53660 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53661 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 53665 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / The edited procedure involves only incidental additional work when performed with the listed procedure. 52346 57410 NCCI Standards of medical/surgical practice 52346 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 64416 NCCI NCCI Refer to Specific Guidelines 52346 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52346 64475 NCCI 52346 69990 BCBST 52346 90775 NCCI 52346 P9612 BCBST 52346 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52351 00910 NCCI NCCI Anesthesia included in surgical procedures NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 198 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52351 00916 NCCI NCCI Anesthesia included in surgical procedures 52351 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 51701 NCCI NCCI Refer to Specific Guidelines 52351 51702 NCCI NCCI Refer to Specific Guidelines 52351 51703 NCCI NCCI Refer to Specific Guidelines 52351 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52351 52001 NCCI NCCI Standards of medical / surgical practice 52351 52005 NCCI NCCI Standards of medical / surgical practice 52351 52007 NCCI Standards of medical/surgical practice 52351 52204 NCCI NCCI Standards of medical / surgical practice 52351 52310 NCCI NCCI Standards of medical / surgical practice 52351 52315 NCCI NCCI Standards of medical / surgical practice 52351 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52351 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52351 57410 NCCI Standards of medical/surgical practice 52351 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 64416 NCCI NCCI Refer to Specific Guidelines 52351 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52351 90775 NCCI Standards of medical/surgical practice 52351 P9612 NCCI NCCI Standards of medical / surgical practice 52351 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52352 00910 NCCI NCCI Anesthesia included in surgical procedures 52352 00916 NCCI NCCI Anesthesia included in surgical procedures 52352 00918 NCCI NCCI Anesthesia included in surgical procedures 52352 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 199 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52352 50945 NCCI NCCI Most extensive procedures 52352 51700 NCCI NCCI Standards of medical / surgical practice 52352 51701 NCCI NCCI Refer to Specific Guidelines 52352 51702 NCCI NCCI Refer to Specific Guidelines 52352 51703 NCCI NCCI Refer to Specific Guidelines 52352 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52352 52001 NCCI NCCI Standards of medical / surgical practice 52352 52005 NCCI NCCI Standards of medical / surgical practice 52352 52007 NCCI Standards of medical/surgical practice 52352 52235 NCCI NCCI Standards of medical / surgical practice 52352 52310 NCCI NCCI Standards of medical / surgical practice 52352 52315 NCCI CPT ‘’separate procedure’’ definition 52352 52341 NCCI NCCI Standards of medical / surgical practice 52352 52342 NCCI NCCI Standards of medical / surgical practice 52352 52343 NCCI NCCI Standards of medical / surgical practice 52352 52344 NCCI NCCI Standards of medical / surgical practice 52352 52345 NCCI NCCI Standards of medical / surgical practice 52352 52351 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52352 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52352 57410 NCCI Standards of medical/surgical practice 52352 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 64416 NCCI NCCI Refer to Specific Guidelines 52352 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52352 90775 NCCI Standards of medical/surgical practice 52352 P9612 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 200 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52352 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52353 00910 NCCI NCCI Anesthesia included in surgical procedures 52353 00916 NCCI NCCI Anesthesia included in surgical procedures 52353 00918 NCCI NCCI Anesthesia included in surgical procedures 52353 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 50945 NCCI NCCI Most extensive procedures 52353 51700 NCCI NCCI Standards of medical / surgical practice 52353 51701 NCCI NCCI Refer to Specific Guidelines 52353 51702 NCCI NCCI Refer to Specific Guidelines 52353 51703 NCCI NCCI Refer to Specific Guidelines 52353 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52353 52001 NCCI NCCI Standards of medical / surgical practice 52353 52005 NCCI NCCI Standards of medical / surgical practice 52353 52007 NCCI Standards of medical/surgical practice 52353 52235 NCCI NCCI Standards of medical / surgical practice 52353 52310 NCCI NCCI Standards of medical / surgical practice 52353 52315 NCCI CPT ‘’separate procedure’’ definition 52353 52317 NCCI NCCI Standards of medical / surgical practice 52353 52318 NCCI NCCI Standards of medical / surgical practice 52353 52341 NCCI NCCI Standards of medical / surgical practice 52353 52342 NCCI NCCI Standards of medical / surgical practice 52353 52343 NCCI NCCI Standards of medical / surgical practice 52353 52344 NCCI NCCI Standards of medical / surgical practice 52353 52345 NCCI NCCI Standards of medical / surgical practice 52353 52351 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 52352 NCCI NCCI Most extensive procedures 52353 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52353 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52353 57410 NCCI Standards of medical/surgical practice 52353 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 201 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52353 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 64416 NCCI NCCI Refer to Specific Guidelines 52353 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52353 90775 NCCI Standards of medical/surgical practice 52353 P9612 NCCI NCCI Standards of medical / surgical practice 52353 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52354 00910 NCCI NCCI Anesthesia included in surgical procedures 52354 00912 NCCI NCCI Anesthesia included in surgical procedures 52354 00916 NCCI NCCI Anesthesia included in surgical procedures 52354 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 51701 NCCI NCCI Refer to Specific Guidelines 52354 51702 NCCI NCCI Refer to Specific Guidelines 52354 51703 NCCI NCCI Refer to Specific Guidelines 52354 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52354 52001 NCCI NCCI Standards of medical / surgical practice 52354 52005 NCCI NCCI Standards of medical / surgical practice 52354 52007 NCCI Standards of medical/surgical practice 52354 52204 NCCI NCCI HCPCS/CPT procedure code definition 52354 52234 NCCI NCCI HCPCS/CPT procedure code definition 52354 52235 NCCI NCCI HCPCS/CPT procedure code definition 52354 52301 NCCI NCCI Most extensive procedures 52354 52310 NCCI NCCI Standards of medical / surgical practice 52354 52315 NCCI NCCI Standards of medical / surgical practice 52354 52341 NCCI NCCI Standards of medical / surgical practice 52354 52342 NCCI NCCI Standards of medical / surgical practice 52354 52343 NCCI NCCI Standards of medical / surgical practice 52354 52351 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52354 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 202 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52354 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52354 57410 NCCI Standards of medical/surgical practice 52354 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 64416 NCCI NCCI Refer to Specific Guidelines 52354 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52354 90775 NCCI Standards of medical/surgical practice 52354 P9612 NCCI NCCI Standards of medical / surgical practice 52354 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52355 00910 NCCI NCCI Anesthesia included in surgical procedures 52355 00912 NCCI NCCI Anesthesia included in surgical procedures 52355 00916 NCCI NCCI Anesthesia included in surgical procedures 52355 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 51701 NCCI NCCI Refer to Specific Guidelines 52355 51702 NCCI NCCI Refer to Specific Guidelines 52355 51703 NCCI NCCI Refer to Specific Guidelines 52355 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52355 52001 NCCI NCCI Standards of medical / surgical practice 52355 52005 NCCI NCCI Standards of medical / surgical practice 52355 52007 NCCI Standards of medical/surgical practice 52355 52204 NCCI NCCI Most extensive procedures 52355 52224 NCCI NCCI Most extensive procedures 52355 52310 NCCI NCCI Standards of medical / surgical practice 52355 52315 NCCI NCCI Standards of medical / surgical practice 52355 52341 NCCI NCCI Standards of medical / surgical practice 52355 52342 NCCI NCCI Standards of medical / surgical practice 52355 52343 NCCI NCCI Standards of medical / surgical practice 52355 52344 NCCI NCCI Standards of medical / surgical practice 52355 52345 NCCI NCCI Standards of medical / surgical practice 52355 52351 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 52354 NCCI NCCI Refer to Specific Guidelines 52355 53020 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 203 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52355 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53660 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53661 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 53665 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52355 57410 NCCI Standards of medical/surgical practice 52355 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 64416 NCCI NCCI Refer to Specific Guidelines 52355 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52355 90775 NCCI Standards of medical/surgical practice 52355 P9612 NCCI NCCI Standards of medical / surgical practice 52355 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52400 00910 NCCI NCCI Anesthesia included in surgical procedures 52400 00916 NCCI NCCI Anesthesia included in surgical procedures 52400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 51701 NCCI NCCI Refer to Specific Guidelines 52400 51702 NCCI NCCI Refer to Specific Guidelines 52400 51703 NCCI NCCI Refer to Specific Guidelines 52400 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52400 52001 NCCI NCCI Standards of medical / surgical practice 52400 52270 NCCI NCCI HCPCS/CPT procedure code definition 52400 52275 NCCI NCCI HCPCS/CPT procedure code definition 52400 52276 NCCI NCCI HCPCS/CPT procedure code definition 52400 52283 NCCI NCCI HCPCS/CPT procedure code definition 52400 52310 NCCI NCCI Standards of medical / surgical practice 52400 52315 NCCI 52400 52400 BCBST 52400 52500 NCCI NCCI Mutually exclusive procedures 52400 53020 NCCI NCCI HCPCS/CPT separate procedure definition NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 204 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52400 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52400 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52400 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52400 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52400 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52400 53660 NCCI NCCI Gender-specific procedures formerly Designation of Sex 52400 53661 NCCI NCCI Gender-specific procedures formerly Designation of Sex 52400 57410 NCCI Standards of medical/surgical practice 52400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 64416 NCCI NCCI Refer to Specific Guidelines 52400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52400 90775 NCCI Standards of medical/surgical practice 52400 P9612 NCCI NCCI Standards of medical / surgical practice 52400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52402 00910 NCCI Anesthesia included in surgical procedures 52402 00916 NCCI Anesthesia included in surgical procedures 52402 36000 NCCI Standards of medical / surgical practice 52402 36410 NCCI Standards of medical / surgical practice 52402 51701 NCCI Standards of medical / surgical practice 52402 51702 NCCI Standards of medical / surgical practice 52402 51703 NCCI Standards of medical / surgical practice 52402 52000 NCCI HCPCS/CPT separate procedure definition 52402 52310 NCCI CPT ‘’separate procedure’’ definition 52402 52315 NCCI CPT ‘’separate procedure’’ definition 52402 53600 NCCI Standards of medical / surgical practice 52402 53601 NCCI Standards of medical / surgical practice 52402 53605 NCCI Standards of medical / surgical practice 52402 53620 NCCI Standards of medical / surgical practice 52402 53621 NCCI Standards of medical / surgical practice 52402 53660 NCCI Standards of medical / surgical practice 52402 53661 NCCI Standards of medical / surgical practice 52402 53665 NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 205 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52402 62319 NCCI Misuse of Column 2 code with Column 1 code 52402 64415 NCCI Misuse of Column 2 code with Column 1 code 52402 64416 NCCI Misuse of Column 2 code with Column 1 code 52402 64417 NCCI Misuse of Column 2 code with Column 1 code 52402 64450 NCCI Misuse of Column 2 code with Column 1 code 52402 69990 NCCI Misuse of Column 2 code with Column 1 code 52402 90775 NCCI Standards of medical/surgical practice 52402 P9612 NCCI Standards of medical / surgical practice 52402 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52450 00910 NCCI NCCI Anesthesia included in surgical procedures 52450 00914 NCCI NCCI Anesthesia included in surgical procedures 52450 00916 NCCI NCCI Anesthesia included in surgical procedures 52450 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 51701 NCCI NCCI Refer to Specific Guidelines 52450 51702 NCCI NCCI Refer to Specific Guidelines 52450 51703 NCCI NCCI Refer to Specific Guidelines 52450 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52450 52001 NCCI NCCI Standards of medical / surgical practice 52450 52281 NCCI 52450 52450 BCBST 52450 52500 NCCI NCCI HCPCS/CPT separate procedure definition 52450 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52450 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52450 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52450 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52450 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52450 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 64416 NCCI NCCI Refer to Specific Guidelines 52450 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52450 90775 NCCI Standards of medical/surgical practice 52450 P9612 NCCI NCCI Standards of medical / surgical practice NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 206 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52450 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52500 00910 NCCI NCCI Anesthesia included in surgical procedures 52500 00912 NCCI NCCI Anesthesia included in surgical procedures 52500 00914 NCCI NCCI Anesthesia included in surgical procedures 52500 00916 NCCI NCCI Anesthesia included in surgical procedures 52500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 51701 NCCI NCCI Refer to Specific Guidelines 52500 51702 NCCI NCCI Refer to Specific Guidelines 52500 51703 NCCI NCCI Refer to Specific Guidelines 52500 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52500 52001 NCCI NCCI Standards of medical / surgical practice 52500 52500 BCBST 52500 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52500 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52500 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52500 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52500 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 64416 NCCI NCCI Refer to Specific Guidelines 52500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52500 90775 NCCI Standards of medical/surgical practice 52500 P9612 NCCI NCCI Standards of medical / surgical practice 52500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52601 00910 NCCI NCCI Anesthesia included in surgical procedures 52601 00914 NCCI NCCI Anesthesia included in surgical procedures 52601 00916 NCCI NCCI Anesthesia included in surgical procedures 52601 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 51040 NCCI NCCI Standards of medical / surgical practice 52601 51102 NCCI Standards of medical/surgical practice 52601 51700 NCCI NCCI Standards of medical / surgical practice 52601 51701 NCCI NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 207 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52601 51702 NCCI NCCI Refer to Specific Guidelines 52601 51703 NCCI NCCI Refer to Specific Guidelines 52601 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52601 52001 NCCI NCCI Standards of medical / surgical practice 52601 52005 NCCI NCCI Standards of medical / surgical practice 52601 52204 NCCI NCCI Standards of medical / surgical practice 52601 52214 NCCI NCCI HCPCS/CPT procedure code definition 52601 52224 NCCI NCCI Standards of medical / surgical practice 52601 52270 NCCI NCCI HCPCS/CPT procedure code definition 52601 52275 NCCI NCCI Standards of medical / surgical practice 52601 52276 NCCI NCCI HCPCS/CPT procedure code definition 52601 52281 NCCI NCCI HCPCS/CPT procedure code definition 52601 52283 NCCI NCCI Standards of medical / surgical practice 52601 52310 NCCI CPT ‘’separate procedure’’ definition 52601 52315 NCCI CPT ‘’separate procedure’’ definition 52601 52400 NCCI NCCI Most extensive procedures 52601 52450 NCCI NCCI Standards of medical / surgical practice 52601 52500 NCCI NCCI HCPCS/CPT separate procedure definition 52601 52601 BCBST 52601 52630 NCCI Mutually exclusive procedures 52601 52640 NCCI Mutually exclusive procedures 52601 52647 NCCI Mutually exclusive procedures 52601 52648 NCCI Mutually exclusive procedures 52601 53020 NCCI NCCI HCPCS/CPT separate procedure definition 52601 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52601 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52601 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52601 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52601 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52601 53850 NCCI Mutually exclusive procedures 52601 53852 NCCI Mutually exclusive procedures 52601 55000 NCCI NCCI Standards of medical / surgical practice 52601 55250 NCCI NCCI HCPCS/CPT separate procedure definition 52601 55700 NCCI NCCI Standards of medical / surgical practice 52601 55705 NCCI 52601 55873 BCBST 52601 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description NCCI Standards of medical / surgical practice NCCI Mutually exclusive procedures / This edit is considered a part of the more extensive listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 208 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52601 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 64416 NCCI NCCI Refer to Specific Guidelines 52601 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52601 90775 NCCI Standards of medical/surgical practice 52601 P9612 NCCI NCCI Standards of medical / surgical practice 52601 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52630 00910 NCCI NCCI Anesthesia included in surgical procedures 52630 00914 NCCI NCCI Anesthesia included in surgical procedures 52630 00916 NCCI NCCI Anesthesia included in surgical procedures 52630 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 51701 NCCI NCCI Refer to Specific Guidelines 52630 51702 NCCI NCCI Refer to Specific Guidelines 52630 51703 NCCI NCCI Refer to Specific Guidelines 52630 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52630 52001 NCCI NCCI Standards of medical / surgical practice 52630 52005 NCCI NCCI Standards of medical / surgical practice 52630 52450 NCCI NCCI Standards of medical / surgical practice 52630 52500 NCCI 52630 52630 BCBST 52630 52640 NCCI Mutually exclusive procedures 52630 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52630 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52630 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52630 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52630 53621 NCCI 52630 55873 BCBST 52630 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 64416 NCCI NCCI Refer to Specific Guidelines 52630 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Mutually exclusive procedures Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT coding manual instruction / guideline NCCI Mutually exclusive procedures / This edit is considered a part of the more extensive listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 209 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52630 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52630 90775 NCCI Standards of medical/surgical practice 52630 P9612 NCCI NCCI Standards of medical / surgical practice 52630 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52640 00910 NCCI NCCI Anesthesia included in surgical procedures 52640 00914 NCCI NCCI Anesthesia included in surgical procedures 52640 00916 NCCI NCCI Anesthesia included in surgical procedures 52640 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 51701 NCCI NCCI Refer to Specific Guidelines 52640 51702 NCCI NCCI Refer to Specific Guidelines 52640 51703 NCCI NCCI Refer to Specific Guidelines 52640 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52640 52001 NCCI NCCI Standards of medical / surgical practice 52640 52276 NCCI NCCI Standards of medical / surgical practice 52640 52283 NCCI NCCI Standards of medical / surgical practice 52640 52450 NCCI NCCI Standards of medical / surgical practice 52640 52640 BCBST 52640 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52640 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52640 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52640 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52640 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52640 55873 NCCI NCCI Mutually exclusive procedures 52640 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 64416 NCCI NCCI Refer to Specific Guidelines 52640 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52640 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description 52640 90775 NCCI Standards of medical/surgical practice 52640 P9612 NCCI NCCI Standards of medical / surgical practice 52640 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52647 00910 NCCI NCCI Anesthesia included in surgical procedures 52647 00914 NCCI NCCI Anesthesia included in surgical procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 210 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52647 00916 NCCI NCCI Anesthesia included in surgical procedures 52647 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 51040 NCCI NCCI Standards of medical / surgical practice 52647 51102 NCCI Standards of medical/surgical practice 52647 51700 NCCI NCCI Standards of medical / surgical practice 52647 51701 NCCI NCCI Refer to Specific Guidelines 52647 51702 NCCI NCCI Refer to Specific Guidelines 52647 51703 NCCI NCCI Refer to Specific Guidelines 52647 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52647 52001 NCCI NCCI Standards of medical / surgical practice 52647 52005 NCCI NCCI HCPCS/CPT procedure code definition 52647 52204 NCCI NCCI HCPCS/CPT procedure code definition 52647 52214 NCCI NCCI HCPCS/CPT procedure code definition 52647 52224 NCCI NCCI HCPCS/CPT procedure code definition 52647 52234 NCCI NCCI HCPCS/CPT procedure code definition 52647 52235 NCCI NCCI HCPCS/CPT procedure code definition 52647 52240 NCCI NCCI HCPCS/CPT procedure code definition 52647 52270 NCCI NCCI HCPCS/CPT procedure code definition 52647 52275 NCCI NCCI HCPCS/CPT procedure code definition 52647 52276 NCCI HCPCS/CPT procedure code definition 52647 52281 NCCI NCCI HCPCS/CPT procedure code definition 52647 52283 NCCI NCCI HCPCS/CPT procedure code definition 52647 52305 NCCI NCCI HCPCS/CPT procedure code definition 52647 52310 NCCI CPT ‘’separate procedure’’ definition 52647 52315 NCCI CPT ‘’separate procedure’’ definition 52647 52400 NCCI NCCI HCPCS/CPT procedure code definition 52647 52500 NCCI NCCI HCPCS/CPT separate procedure definition 52647 52630 NCCI Mutually exclusive procedures 52647 52640 NCCI Mutually exclusive procedures 52647 52647 BCBST 52647 52700 NCCI NCCI Standards of medical / surgical practice 52647 53000 NCCI NCCI HCPCS/CPT procedure code definition 52647 53020 NCCI CPT ‘’separate procedure’’ definition 52647 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52647 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52647 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52647 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52647 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 211 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52647 53850 NCCI Mutually exclusive procedures 52647 53852 NCCI Mutually exclusive procedures 52647 55000 NCCI NCCI Standards of medical / surgical practice 52647 55200 NCCI NCCI HCPCS/CPT procedure code definition 52647 55250 NCCI HCPCS/CPT procedure code definition 52647 55700 NCCI NCCI Standards of medical / surgical practice 52647 55705 NCCI NCCI HCPCS/CPT procedure code definition 52647 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 64416 NCCI NCCI Refer to Specific Guidelines 52647 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52647 90775 NCCI Standards of medical/surgical practice 52647 J2001 NCCI Misuse of column 2 code with column 1 code 52647 P9612 NCCI NCCI Standards of medical / surgical practice 52647 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52648 00910 NCCI NCCI Anesthesia included in surgical procedures 52648 00914 NCCI NCCI Anesthesia included in surgical procedures 52648 00916 NCCI NCCI Anesthesia included in surgical procedures 52648 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 51040 NCCI NCCI Standards of medical / surgical practice 52648 51700 NCCI NCCI Standards of medical / surgical practice 52648 51701 NCCI NCCI Refer to Specific Guidelines 52648 51702 NCCI NCCI Refer to Specific Guidelines 52648 51703 NCCI NCCI Refer to Specific Guidelines 52648 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52648 52001 NCCI NCCI Standards of medical / surgical practice 52648 52005 NCCI NCCI HCPCS/CPT procedure code definition 52648 52204 NCCI NCCI HCPCS/CPT procedure code definition 52648 52214 NCCI NCCI HCPCS/CPT procedure code definition 52648 52224 NCCI NCCI HCPCS/CPT procedure code definition 52648 52234 NCCI NCCI HCPCS/CPT procedure code definition 52648 52235 NCCI NCCI HCPCS/CPT procedure code definition 52648 52240 NCCI NCCI HCPCS/CPT procedure code definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 212 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52648 52270 NCCI NCCI HCPCS/CPT procedure code definition 52648 52275 NCCI NCCI HCPCS/CPT procedure code definition 52648 52276 NCCI HCPCS/CPT procedure code definition 52648 52281 NCCI NCCI HCPCS/CPT procedure code definition 52648 52283 NCCI NCCI HCPCS/CPT procedure code definition 52648 52305 NCCI NCCI HCPCS/CPT procedure code definition 52648 52310 NCCI CPT ‘’separate procedure’’ definition 52648 52315 NCCI CPT ‘’separate procedure’’ definition 52648 52400 NCCI NCCI HCPCS/CPT procedure code definition 52648 52500 NCCI NCCI HCPCS/CPT separate procedure definition 52648 52630 NCCI Mutually exclusive procedures 52648 52640 NCCI Mutually exclusive procedures 52648 52647 NCCI Mutually exclusive procedures 52648 52648 BCBST 52648 52700 NCCI NCCI Standards of medical / surgical practice 52648 53000 NCCI NCCI HCPCS/CPT procedure code definition 52648 53020 NCCI CPT ‘’separate procedure’’ definition 52648 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52648 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52648 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52648 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52648 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52648 53850 NCCI Mutually exclusive procedures 52648 53852 NCCI Mutually exclusive procedures 52648 55000 NCCI NCCI Standards of medical / surgical practice 52648 55200 NCCI NCCI HCPCS/CPT procedure code definition 52648 55250 NCCI HCPCS/CPT procedure code definition 52648 55700 NCCI NCCI Standards of medical / surgical practice 52648 55705 NCCI NCCI Standards of medical / surgical practice 52648 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 64416 NCCI NCCI Refer to Specific Guidelines 52648 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52648 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 213 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52648 90775 NCCI Standards of medical/surgical practice 52648 P9612 NCCI NCCI Standards of medical / surgical practice 52648 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 52649 00910 NCCI Anesthesia service included in surgical procedure 52649 00914 NCCI Anesthesia service included in surgical procedure 52649 00916 NCCI Anesthesia service included in surgical procedure 52649 36000 NCCI Standards of medical/surgical practice 52649 36410 NCCI Standards of medical/surgical practice 52649 37202 NCCI Misuse of column 2 code with column 1 code 52649 51040 NCCI Standards of medical/surgical practice 52649 51102 NCCI Standards of medical/surgical practice 52649 51700 NCCI Standards of medical/surgical practice 52649 51701 NCCI CPT manual and CMS coding manual instructions 52649 51702 NCCI CPT manual and CMS coding manual instructions 52649 51703 NCCI CPT manual and CMS coding manual instructions 52649 52000 NCCI CPT manual and CMS coding manual instructions 52649 52001 NCCI Standards of medical/surgical practice 52649 52005 NCCI HCPCS/CPT procedure code definition 52649 52204 NCCI HCPCS/CPT procedure code definition 52649 52214 NCCI HCPCS/CPT procedure code definition 52649 52224 NCCI HCPCS/CPT procedure code definition 52649 52234 NCCI HCPCS/CPT procedure code definition 52649 52235 NCCI HCPCS/CPT procedure code definition 52649 52240 NCCI HCPCS/CPT procedure code definition 52649 52270 NCCI HCPCS/CPT procedure code definition 52649 52275 NCCI HCPCS/CPT procedure code definition 52649 52276 NCCI CPT manual and CMS coding manual instructions 52649 52281 NCCI CPT manual and CMS coding manual instructions 52649 52283 NCCI HCPCS/CPT procedure code definition 52649 52305 NCCI HCPCS/CPT procedure code definition 52649 52310 NCCI CPT ‘’separate procedure’’ definition 52649 52315 NCCI CPT ‘’separate procedure’’ definition 52649 52400 NCCI HCPCS/CPT procedure code definition 52649 52450 NCCI Mutually exclusive procedures 52649 52500 NCCI CPT ‘’separate procedure’’ definition 52649 52601 NCCI CPT manual and CMS coding manual instructions 52649 52630 NCCI Mutually exclusive procedures 52649 52640 NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 214 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52649 52647 NCCI CPT manual and CMS coding manual instructions 52649 52648 NCCI CPT manual and CMS coding manual instructions 52649 52700 NCCI Standards of medical/surgical practice 52649 53000 NCCI HCPCS/CPT procedure code definition 52649 53020 NCCI CPT manual and CMS coding manual instructions 52649 53600 NCCI CPT manual and CMS coding manual instructions 52649 53601 NCCI CPT manual and CMS coding manual instructions 52649 53605 NCCI CPT manual and CMS coding manual instructions 52649 53620 NCCI CPT manual and CMS coding manual instructions 52649 53621 NCCI CPT manual and CMS coding manual instructions 52649 53660 NCCI Mutually exclusive procedures 52649 53661 NCCI Mutually exclusive procedures 52649 53665 NCCI Mutually exclusive procedures 52649 55000 NCCI Standards of medical/surgical practice 52649 55200 NCCI HCPCS/CPT procedure code definition 52649 55250 NCCI CPT manual and CMS coding manual instructions 52649 55700 NCCI Standards of medical/surgical practice1 52649 55705 NCCI Standards of medical/surgical practice 52649 62318 NCCI Misuse of column 2 code with column 1 code 52649 62319 NCCI Misuse of column 2 code with column 1 code 52649 64415 NCCI Misuse of column 2 code with column 1 code 52649 64416 NCCI Misuse of column 2 code with column 1 code 52649 64417 NCCI Misuse of column 2 code with column 1 code 52649 64450 NCCI Misuse of column 2 code with column 1 code 52649 64470 NCCI Misuse of column 2 code with column 1 code 52649 64475 NCCI Misuse of column 2 code with column 1 code 52649 69990 NCCI Misuse of column 2 code with column 1 code 52649 90775 NCCI Standards of medical/surgical practice 52649 P9612 NCCI Standards of medical/surgical practice 52700 00910 NCCI NCCI Anesthesia included in surgical procedures 52700 00914 NCCI NCCI Anesthesia included in surgical procedures 52700 00916 NCCI NCCI Anesthesia included in surgical procedures 52700 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 51701 NCCI NCCI Refer to Specific Guidelines 52700 51702 NCCI NCCI Refer to Specific Guidelines 52700 51703 NCCI NCCI Refer to Specific Guidelines 52700 52000 NCCI NCCI HCPCS/CPT separate procedure definition 52700 52001 NCCI NCCI Standards of medical / surgical practice 52700 52700 BCBST Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 215 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 52700 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52700 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52700 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52700 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52700 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 52700 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 64416 NCCI NCCI Refer to Specific Guidelines 52700 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 52700 90775 NCCI Standards of medical/surgical practice 52700 P9612 NCCI NCCI Standards of medical / surgical practice 52700 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 51701 NCCI Standards of medical / surgical practice 53000 51702 NCCI NCCI Refer to Specific Guidelines 53000 51703 NCCI Standards of medical/surgical practice 53000 53000 BCBST 53000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 64416 NCCI NCCI Refer to Specific Guidelines 53000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53000 90775 NCCI Standards of medical/surgical practice 53000 J2001 NCCI Misuse of column 2 code with column 1 code 53000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53010 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 51701 NCCI Standards of medical / surgical practice 53010 51702 NCCI NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 216 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53010 51703 NCCI Standards of medical/surgical practice 53010 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53010 53010 BCBST 53010 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 64416 NCCI NCCI Refer to Specific Guidelines 53010 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53010 NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description 69990 NCCI 53010 90775 NCCI Standards of medical/surgical practice 53010 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 51701 NCCI Standards of medical / surgical practice 53020 51703 NCCI Standards of medical/surgical practice 53020 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53020 53020 BCBST 53020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 64416 NCCI NCCI Refer to Specific Guidelines 53020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53020 90775 NCCI Standards of medical/surgical practice 53020 J2001 NCCI Misuse of column 2 code with column 1 code 53020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53025 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 51701 NCCI Standards of medical / surgical practice 53025 51703 NCCI Standards of medical/surgical practice 53025 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53025 53020 NCCI NCCI HCPCS/CPT separate procedure definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 217 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53025 53025 BCBST Code redundant to self/should not be reported more than once due to standard description 53025 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 64416 NCCI NCCI Refer to Specific Guidelines 53025 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53025 90775 NCCI Standards of medical/surgical practice 53025 J2001 NCCI Misuse of column 2 code with column 1 code 53025 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53040 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 51701 NCCI Standards of medical / surgical practice 53040 51702 NCCI NCCI Refer to Specific Guidelines 53040 51703 NCCI Standards of medical/surgical practice 53040 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53040 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53040 53025 NCCI 53040 53040 BCBST 53040 53060 NCCI NCCI Most extensive procedures 53040 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53040 53265 NCCI NCCI Most extensive procedures 53040 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 64416 NCCI NCCI Refer to Specific Guidelines 53040 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53040 90775 NCCI Standards of medical/surgical practice 53040 J2001 NCCI Misuse of column 2 code with column 1 code 53040 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53060 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 218 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53060 51701 NCCI Standards of medical / surgical practice 53060 51702 NCCI NCCI Refer to Specific Guidelines 53060 51703 NCCI Standards of medical/surgical practice 53060 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53060 53060 BCBST 53060 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53060 53270 NCCI NCCI Mutually exclusive procedures 53060 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 64416 NCCI NCCI Refer to Specific Guidelines 53060 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53060 90775 NCCI Standards of medical/surgical practice 53060 J2001 NCCI Misuse of column 2 code with column 1 code 53060 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53080 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 51701 NCCI Standards of medical/surgical practice 53080 51702 NCCI Standards of medical/surgical practice 53080 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53080 53080 BCBST 53080 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 64416 NCCI NCCI Refer to Specific Guidelines 53080 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53080 90775 NCCI Standards of medical/surgical practice 53080 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53085 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 51701 NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 219 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53085 51702 NCCI NCCI Refer to Specific Guidelines 53085 51703 NCCI Standards of medical/surgical practice 53085 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53085 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53085 53085 BCBST 53085 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 64416 NCCI NCCI Refer to Specific Guidelines 53085 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53085 90775 NCCI Standards of medical/surgical practice 53085 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53200 10021 NCCI NCCI Sequential procedures 53200 10022 NCCI NCCI Sequential procedures 53200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 51701 NCCI Standards of medical / surgical practice 53200 51702 NCCI NCCI Refer to Specific Guidelines 53200 51703 NCCI Standards of medical/surgical practice 53200 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53200 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53200 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 64416 NCCI NCCI Refer to Specific Guidelines 53200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53200 90775 NCCI Standards of medical/surgical practice 53200 J2001 NCCI Misuse of column 2 code with column 1 code 53200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 220 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53210 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 51701 NCCI Standards of medical / surgical practice 53210 51702 NCCI NCCI Refer to Specific Guidelines 53210 51703 NCCI Standards of medical/surgical practice 53210 52301 NCCI NCCI Sequential procedures 53210 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53210 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53210 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53210 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53210 53200 NCCI 53210 53210 BCBST 53210 53220 NCCI 53210 53250 NCCI NCCI Gender-specific procedures formerly Designation of Sex 53210 53260 NCCI NCCI Most extensive procedures 53210 53265 NCCI NCCI Most extensive procedures 53210 53270 NCCI NCCI Most extensive procedures 53210 53275 NCCI NCCI Most extensive procedures 53210 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 64416 NCCI NCCI Refer to Specific Guidelines 53210 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53210 90775 NCCI Standards of medical/surgical practice 53210 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53215 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 51701 NCCI Standards of medical / surgical practice 53215 51702 NCCI NCCI Refer to Specific Guidelines 53215 51703 NCCI Standards of medical/surgical practice 53215 52301 NCCI NCCI Sequential procedures 53215 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53215 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53215 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53215 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53215 53080 NCCI NCCI HCPCS/CPT separate procedure definition NCCI Most extensive procedures Code redundant to self/should not be reported more than once due to standard description NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 221 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53215 53200 NCCI NCCI Most extensive procedures 53215 53210 NCCI NCCI Gender-specific procedures formerly Designation of Sex 53215 53215 BCBST 53215 53220 NCCI NCCI Most extensive procedures 53215 53235 NCCI NCCI Most extensive procedures 53215 53250 NCCI NCCI Most extensive procedures 53215 53260 NCCI NCCI Most extensive procedures 53215 53265 NCCI NCCI Most extensive procedures 53215 53270 NCCI NCCI Most extensive procedures 53215 53275 NCCI NCCI Most extensive procedures 53215 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 64416 NCCI NCCI Refer to Specific Guidelines 53215 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53215 90775 NCCI Standards of medical/surgical practice 53215 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 51701 NCCI Standards of medical / surgical practice 53220 51702 NCCI NCCI Refer to Specific Guidelines 53220 51703 NCCI Standards of medical/surgical practice 53220 52301 NCCI NCCI Sequential procedures 53220 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53220 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53220 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53220 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53220 53080 NCCI 53220 53220 BCBST 53220 56740 NCCI NCCI Most extensive procedures 53220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 64416 NCCI NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT separate procedure definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 222 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53220 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 53220 90775 NCCI Standards of medical/surgical practice 53220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53230 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 51701 NCCI Standards of medical / surgical practice 53230 51702 NCCI NCCI Refer to Specific Guidelines 53230 51703 NCCI Standards of medical/surgical practice 53230 52301 NCCI NCCI Sequential procedures 53230 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53230 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53230 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53230 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53230 53230 BCBST 53230 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 64416 NCCI NCCI Refer to Specific Guidelines 53230 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53230 90775 NCCI Standards of medical/surgical practice 53230 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53235 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 51701 NCCI Standards of medical / surgical practice 53235 51702 NCCI NCCI Refer to Specific Guidelines 53235 51703 NCCI Standards of medical/surgical practice 53235 52301 NCCI NCCI Sequential procedures 53235 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53235 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53235 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53235 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53235 53080 NCCI NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 223 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53235 53230 NCCI 53235 53235 BCBST 53235 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 64416 NCCI NCCI Refer to Specific Guidelines 53235 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53235 90775 NCCI Standards of medical/surgical practice 53235 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 51701 NCCI Standards of medical / surgical practice 53240 51702 NCCI NCCI Refer to Specific Guidelines 53240 51703 NCCI Standards of medical/surgical practice 53240 52301 NCCI NCCI Sequential procedures 53240 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53240 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53240 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53240 53025 NCCI 53240 53240 BCBST 53240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 64416 NCCI NCCI Refer to Specific Guidelines 53240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53240 90775 NCCI Standards of medical/surgical practice 53240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53250 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 51701 NCCI Standards of medical / surgical practice 53250 51702 NCCI NCCI Refer to Specific Guidelines 53250 51703 NCCI Standards of medical/surgical practice NCCI Mutually exclusive procedures Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 224 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53250 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53250 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53250 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53250 53040 NCCI NCCI Most extensive procedures 53250 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53250 53230 NCCI 53250 53250 BCBST 53250 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 64416 NCCI NCCI Refer to Specific Guidelines 53250 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53250 90775 NCCI Standards of medical/surgical practice 53250 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53260 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 51701 NCCI Standards of medical / surgical practice 53260 51702 NCCI NCCI Refer to Specific Guidelines 53260 51703 NCCI Standards of medical/surgical practice 53260 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53260 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53260 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53260 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53260 53230 NCCI NCCI HCPCS/CPT separate procedure definition 53260 53260 BCBST 53260 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 64416 NCCI NCCI Refer to Specific Guidelines 53260 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53260 90775 NCCI Standards of medical/surgical practice NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 225 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53260 J2001 NCCI Misuse of column 2 code with column 1 code 53260 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53265 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 51701 NCCI Standards of medical / surgical practice 53265 51702 NCCI NCCI Refer to Specific Guidelines 53265 51703 NCCI Standards of medical/surgical practice 53265 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53265 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53265 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53265 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53265 53230 NCCI NCCI HCPCS/CPT separate procedure definition 53265 53265 BCBST 53265 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 64416 NCCI NCCI Refer to Specific Guidelines 53265 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53265 90775 NCCI Standards of medical/surgical practice 53265 J2001 NCCI Misuse of column 2 code with column 1 code 53265 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53270 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 51701 NCCI Standards of medical / surgical practice 53270 51702 NCCI NCCI Refer to Specific Guidelines 53270 51703 NCCI Standards of medical/surgical practice 53270 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53270 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53270 53230 NCCI 53270 53270 BCBST 53270 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 64416 NCCI NCCI Refer to Specific Guidelines 53270 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 226 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53270 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53270 90775 NCCI Standards of medical/surgical practice 53270 J2001 NCCI Misuse of column 2 code with column 1 code 53270 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53275 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 51701 NCCI Standards of medical / surgical practice 53275 51702 NCCI NCCI Refer to Specific Guidelines 53275 51703 NCCI Standards of medical/surgical practice 53275 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53275 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53275 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53275 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53275 53230 NCCI 53275 53275 BCBST 53275 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 64416 NCCI NCCI Refer to Specific Guidelines 53275 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53275 90775 NCCI Standards of medical/surgical practice 53275 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 51701 NCCI Standards of medical / surgical practice 53400 51702 NCCI NCCI Refer to Specific Guidelines 53400 51703 NCCI Standards of medical/surgical practice 53400 52301 NCCI NCCI Sequential procedures 53400 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53400 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53400 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53400 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53400 53400 BCBST 53400 53405 NCCI NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. OB-GYN procedure redundant to itself. NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 227 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53400 53502 NCCI NCCI Standards of medical / surgical practice 53400 53505 NCCI NCCI Standards of medical / surgical practice 53400 53510 NCCI NCCI Standards of medical / surgical practice 53400 53515 NCCI NCCI Standards of medical / surgical practice 53400 53520 NCCI NCCI Standards of medical / surgical practice 53400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 64416 NCCI NCCI Refer to Specific Guidelines 53400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53400 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 53400 90775 NCCI Standards of medical/surgical practice 53400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53405 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 51701 NCCI Standards of medical / surgical practice 53405 51702 NCCI NCCI Refer to Specific Guidelines 53405 51703 NCCI Standards of medical/surgical practice 53405 52301 NCCI NCCI Sequential procedures 53405 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53405 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53405 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53405 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53405 53405 BCBST 53405 53502 NCCI NCCI Standards of medical / surgical practice 53405 53505 NCCI NCCI Standards of medical / surgical practice 53405 53510 NCCI NCCI Standards of medical / surgical practice 53405 53515 NCCI NCCI Standards of medical / surgical practice 53405 53520 NCCI NCCI Standards of medical / surgical practice 53405 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 64416 NCCI NCCI Refer to Specific Guidelines 53405 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code OB-GYN procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 228 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53405 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53405 90775 NCCI Standards of medical/surgical practice 53405 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53410 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 51701 NCCI Standards of medical / surgical practice 53410 51702 NCCI NCCI Refer to Specific Guidelines 53410 51703 NCCI Standards of medical/surgical practice 53410 51990 NCCI NCCI Most extensive procedures 53410 51992 NCCI NCCI Most extensive procedures 53410 52301 NCCI NCCI Sequential procedures 53410 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53410 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53410 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53410 53080 NCCI 53410 53410 BCBST 53410 53502 NCCI NCCI Standards of medical / surgical practice 53410 53505 NCCI NCCI Standards of medical / surgical practice 53410 53510 NCCI NCCI Standards of medical / surgical practice 53410 53515 NCCI NCCI Standards of medical / surgical practice 53410 53520 NCCI NCCI Standards of medical / surgical practice 53410 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 64416 NCCI NCCI Refer to Specific Guidelines 53410 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53410 NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. 69990 NCCI 53410 90775 NCCI Standards of medical/surgical practice 53410 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53415 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 51701 NCCI Standards of medical / surgical practice 53415 51702 NCCI NCCI Refer to Specific Guidelines 53415 51703 NCCI Standards of medical/surgical practice 53415 51990 NCCI NCCI Most extensive procedures 53415 51992 NCCI NCCI Most extensive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 229 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53415 52301 NCCI NCCI Sequential procedures 53415 52640 NCCI NCCI Standards of medical / surgical practice 53415 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53415 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53415 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53415 53080 NCCI 53415 53415 BCBST 53415 53502 NCCI NCCI Standards of medical / surgical practice 53415 53505 NCCI NCCI Standards of medical / surgical practice 53415 53510 NCCI NCCI Standards of medical / surgical practice 53415 53515 NCCI NCCI Standards of medical / surgical practice 53415 53520 NCCI NCCI Standards of medical / surgical practice 53415 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 64416 NCCI NCCI Refer to Specific Guidelines 53415 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53415 90775 NCCI Standards of medical/surgical practice 53415 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 51701 NCCI Standards of medical / surgical practice 53420 51702 NCCI NCCI Refer to Specific Guidelines 53420 51703 NCCI Standards of medical/surgical practice 53420 51990 NCCI NCCI Most extensive procedures 53420 51992 NCCI NCCI Most extensive procedures 53420 52301 NCCI NCCI Sequential procedures 53420 52640 NCCI NCCI Standards of medical / surgical practice 53420 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53420 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53420 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53420 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53420 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53420 53420 BCBST 53420 53425 NCCI NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. Procedure redundant to itself. NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 230 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53420 53502 NCCI NCCI Standards of medical / surgical practice 53420 53505 NCCI NCCI Standards of medical / surgical practice 53420 53510 NCCI NCCI Standards of medical / surgical practice 53420 53515 NCCI NCCI Standards of medical / surgical practice 53420 53520 NCCI NCCI Standards of medical / surgical practice 53420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 64416 NCCI NCCI Refer to Specific Guidelines 53420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53420 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 53420 90775 NCCI Standards of medical/surgical practice 53420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53425 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 51701 NCCI Standards of medical / surgical practice 53425 51702 NCCI NCCI Refer to Specific Guidelines 53425 51703 NCCI Standards of medical/surgical practice 53425 51990 NCCI NCCI Most extensive procedures 53425 51992 NCCI NCCI Most extensive procedures 53425 52301 NCCI NCCI Sequential procedures 53425 52640 NCCI NCCI Standards of medical / surgical practice 53425 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53425 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53425 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53425 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53425 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53425 53425 BCBST 53425 53502 NCCI NCCI Standards of medical / surgical practice 53425 53505 NCCI NCCI Standards of medical / surgical practice 53425 53510 NCCI NCCI Standards of medical / surgical practice 53425 53515 NCCI NCCI Standards of medical / surgical practice 53425 53520 NCCI NCCI Standards of medical / surgical practice 53425 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 231 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53425 64416 NCCI NCCI Refer to Specific Guidelines 53425 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53425 90775 NCCI Standards of medical/surgical practice 53425 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53430 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 51701 NCCI NCCI Refer to Specific Guidelines 53430 51702 NCCI NCCI Refer to Specific Guidelines 53430 51703 NCCI Standards of medical/surgical practice 53430 51990 NCCI NCCI Most extensive procedures 53430 51992 NCCI NCCI Most extensive procedures 53430 52301 NCCI NCCI Sequential procedures 53430 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53430 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53430 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53430 53080 NCCI 53430 53400 BCBST OB-GYN procedure -- standard subset procedure rationale. 53430 53405 BCBST OB-GYN procedure -- standard subset procedure rationale. 53430 53430 BCBST OB-GYN procedure redundant to itself. 53430 53502 NCCI NCCI Standards of medical / surgical practice 53430 53505 NCCI NCCI Standards of medical / surgical practice 53430 53510 NCCI NCCI Standards of medical / surgical practice 53430 53515 NCCI NCCI Standards of medical / surgical practice 53430 53520 NCCI NCCI Standards of medical / surgical practice 53430 53665 BCBST 53430 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 64416 NCCI NCCI Refer to Specific Guidelines 53430 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53430 90775 NCCI Standards of medical/surgical practice NCCI HCPCS/CPT separate procedure definition OB-GYN procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 232 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53430 S0020 CPT 53431 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12011 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12013 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12014 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12015 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12016 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12017 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12018 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 233 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53431 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12051 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12052 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12053 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12054 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12055 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12056 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 12057 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13100 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13101 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13102 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53431 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 51701 NCCI Standards of medical / surgical practice 53431 51702 NCCI NCCI Refer to Specific Guidelines 53431 51703 NCCI Standards of medical/surgical practice 53431 51990 BCBST NCCI Most extensive procedures / The edited code is redundant to the listed code to account for a laparoscopic case converted to an open procedure. When a laparoscopic service is attempted and fails and another surgical service is necessary, only the successful service is allowed. Note that it may be appropriate to reimburse the edited laparoscopy if it represents a distinct diagnostic service prior to the open surgical service and the decision to perform surgery was made on the basis of the laparoscopy, or if it represents a separate surgical procedure sufficiently unrelated to the open procedure and requiring significant additional work. 53431 51992 BCBST NCCI Most extensive procedures / The edited code is redundant to the listed code to account for a laparoscopic case converted to an open procedure. When a laparoscopic service is attempted and fails and another surgical service is necessary, only the successful service is allowed. Note that it may be appropriate to reimburse the edited laparoscopy if it represents a distinct diagnostic service prior to the open surgical service and the decision to perform surgery was made on the basis of the laparoscopy, or if it represents a separate surgical procedure sufficiently unrelated to the open procedure and requiring significant additional work. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 234 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53431 52301 BCBST NCCI Sequential procedures / Edited code not allowed when used to report incidental surgical cystourethroscopy at the time of the definitive procedure. 53431 53000 BCBST NCCI HCPCS/CPT separate procedure definition / Component procedure if used to report services at the same session as the listed procedure. 53431 53010 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53431 53020 BCBST Edited code not allowed if used to report incidental meatotomy at the time of the listed procedure. NCCI CPT separate procedure definition 53431 53025 BCBST NCCI HCPCS/CPT separate procedure definition / Incompatible code combination or component. Listed procedure is performed on adult patients. 53431 53080 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53431 53431 BCBST Procedure redundant to itself. 53431 53502 BCBST NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. 53431 53505 BCBST NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. 53431 53510 BCBST NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. 53431 53515 BCBST NCCI Standards of medical / surgical practice / Component procedure if used to report services at the same session as the listed procedure. 53431 53520 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53431 53600 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53431 53601 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53431 53605 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53431 53660 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53431 53661 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53431 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 64416 NCCI NCCI Refer to Specific Guidelines 53431 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53431 69990 BCBST 53431 90775 NCCI Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 235 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53431 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53440 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 51701 NCCI Standards of medical / surgical practice 53440 51702 NCCI NCCI Refer to Specific Guidelines 53440 51703 NCCI Standards of medical/surgical practice 53440 51990 NCCI NCCI Most extensive procedures 53440 51992 NCCI NCCI Most extensive procedures 53440 52301 NCCI NCCI Sequential procedures 53440 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53440 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53440 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53440 53440 BCBST 53440 53444 NCCI NCCI HCPCS/CPT procedure code definition 53440 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 64416 NCCI NCCI Refer to Specific Guidelines 53440 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53440 90775 NCCI Standards of medical/surgical practice 53440 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53442 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 51701 NCCI Standards of medical / surgical practice 53442 51702 NCCI NCCI Refer to Specific Guidelines 53442 51703 NCCI Standards of medical/surgical practice 53442 52301 NCCI NCCI Sequential procedures 53442 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53442 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53442 53440 NCCI NCCI Mutually exclusive procedures 53442 53442 BCBST 53442 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 64416 NCCI NCCI Refer to Specific Guidelines 53442 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 236 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53442 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53442 90775 NCCI Standards of medical/surgical practice 53442 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53444 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12011 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12013 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12014 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12015 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12016 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12017 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12018 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 237 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53444 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12051 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12052 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12053 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12054 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12055 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12056 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 12057 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13100 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13101 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13102 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53444 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 51701 NCCI Standards of medical / surgical practice 53444 51702 NCCI NCCI Refer to Specific Guidelines 53444 51703 NCCI Standards of medical/surgical practice 53444 52301 BCBST Edited code not allowed when used to report incidental surgical cystourethroscopy at the time of the definitive procedure. 53444 53000 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53444 53010 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53444 53020 BCBST Edited code not allowed if used to report incidental meatotomy at the time of the listed procedure. NCCI CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 238 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53444 53025 BCBST Incompatible code combination or component. Listed procedure is performed on adult patients. 53444 53080 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53444 53444 BCBST Procedure redundant to itself. 53444 53446 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 53449 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 53600 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53444 53601 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53444 53605 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53444 53660 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53444 53661 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53444 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 64416 NCCI NCCI Refer to Specific Guidelines 53444 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53444 64475 NCCI 53444 69990 BCBST 53444 90775 NCCI Standards of medical/surgical practice 53444 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53445 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 51701 NCCI Standards of medical / surgical practice 53445 51702 NCCI NCCI Refer to Specific Guidelines 53445 51703 NCCI Standards of medical/surgical practice 53445 51990 NCCI NCCI Most extensive procedures 53445 51992 NCCI NCCI Most extensive procedures 53445 52301 NCCI NCCI Sequential procedures 53445 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53445 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53445 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53445 53080 NCCI NCCI HCPCS/CPT separate procedure definition NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 239 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53445 53444 NCCI 53445 53444 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53445 53444 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53445 53445 BCBST Procedure redundant to itself. 53445 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 64416 NCCI NCCI Refer to Specific Guidelines 53445 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53445 90775 NCCI Standards of medical/surgical practice 53445 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53446 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12011 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12013 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12014 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12015 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12016 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12017 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12018 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 240 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53446 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12051 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12052 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12053 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12054 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12055 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12056 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 12057 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13100 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13101 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13102 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53446 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 241 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53446 51701 NCCI Standards of medical / surgical practice 53446 51702 NCCI NCCI Refer to Specific Guidelines 53446 51703 NCCI 53446 52301 BCBST Edited code not allowed when used to report incidental surgical cystourethroscopy at the time of the definitive procedure. 53446 53000 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53446 53010 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53446 53020 BCBST Edited code not allowed if used to report incidental meatotomy at the time of the listed procedure. NCCI CPT separate procedure definition 53446 53025 BCBST Incompatible code combination or component. Listed procedure is performed on adult patients. 53446 53080 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53446 53445 NCCI 53446 53446 BCBST Procedure redundant to itself. 53446 53600 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53446 53601 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53446 53605 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53446 53660 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53446 53661 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53446 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 64416 NCCI NCCI Refer to Specific Guidelines 53446 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53446 69990 BCBST 53446 90775 NCCI Standards of medical/surgical practice 53446 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53447 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 51701 NCCI Standards of medical / surgical practice Standards of medical/surgical practice NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 242 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53447 51702 NCCI NCCI Refer to Specific Guidelines 53447 51703 NCCI Standards of medical/surgical practice 53447 52301 NCCI NCCI Sequential procedures 53447 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53447 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53447 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53447 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53447 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53447 53440 NCCI NCCI Standards of medical / surgical practice 53447 53444 NCCI 53447 53444 BCBST 53447 53445 NCCI 53447 53445 NCCI 53447 53445 BCBST 53447 53446 NCCI 53447 53446 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure; rebundles with principle procedure 53445 to 53447. 53447 53446 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure; rebundles with principle procedure 53445 to 53447. 53447 53447 BCBST Procedure redundant to itself. 53447 53449 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 64416 NCCI NCCI Refer to Specific Guidelines 53447 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53447 90775 NCCI Standards of medical/surgical practice 53447 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53448 11004 NCCI Misuse of column 2 code with column 1 code 53448 11005 NCCI Misuse of column 2 code with column 1 code 53448 11006 NCCI Misuse of column 2 code with column 1 code 53448 11040 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 53448 11041 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. NCCI Refer to Specific Guidelines NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. NCCI Refer to Specific Guidelines NCCI HCPCS/CPT procedure code definition NCCI HCPCS/CPT procedure code definition / Component principle procedure of 53447; rebundles with 53446 to 53447. NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 243 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53448 11042 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 53448 11043 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 53448 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12011 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12013 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12014 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12015 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12016 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12017 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12018 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 244 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53448 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12051 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12052 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12053 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12054 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12055 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12056 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 12057 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13100 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13101 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13102 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 53448 37202 NCCI 53448 51701 NCCI Standards of medical / surgical practice 53448 51702 NCCI NCCI Refer to Specific Guidelines 53448 51703 NCCI 53448 52301 BCBST Edited code not allowed when used to report incidental surgical cystourethroscopy at the time of the definitive procedure. 53448 53000 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53448 53010 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition 53448 53020 BCBST Edited code not allowed if used to report incidental meatotomy at the time of the listed procedure. NCCI CPT separate procedure definition 53448 53025 BCBST Incompatible code combination or component. Listed procedure is performed on adult patients. 53448 53080 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. NCCI CPT separate procedure definition NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 245 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53448 53440 NCCI 53448 53444 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53444 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53444 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed during the same session. 53448 53444 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed during the same session. 53448 53445 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 53448 53445 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53445 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53445 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 53448 53446 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53446 BCBST NCCI HCPCS/CPT procedure code definition / Component procedure if used to report services at the same session as the listed procedure. 53448 53446 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 53448 53446 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 53448 53447 BCBST Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 53448 53448 BCBST Procedure redundant to itself. 53448 53449 NCCI 53448 53600 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53448 53601 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53448 53605 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. 53448 53660 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53448 53661 BCBST Edited code not allowed if used to report incidental urethral dilation at the time of the listed procedure. Listed procedure typically performed on males; note the gender inconsistency with the edited code. 53448 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 64416 NCCI NCCI Refer to Specific Guidelines 53448 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Standards of medical / surgical practice NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 246 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53448 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53448 69990 BCBST 53448 90775 NCCI Standards of medical/surgical practice 53448 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53449 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 51701 NCCI Standards of medical / surgical practice 53449 51702 NCCI NCCI Refer to Specific Guidelines 53449 51703 NCCI Standards of medical/surgical practice 53449 52301 NCCI NCCI Sequential procedures 53449 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53449 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53449 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53449 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53449 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53449 53449 BCBST 53449 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 64416 NCCI NCCI Refer to Specific Guidelines 53449 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53449 90775 NCCI Standards of medical/surgical practice 53449 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53450 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 51701 NCCI Standards of medical / surgical practice 53450 51702 NCCI NCCI Refer to Specific Guidelines 53450 51703 NCCI Standards of medical/surgical practice 53450 52301 NCCI NCCI Sequential procedures 53450 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53450 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53450 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53450 53080 NCCI 53450 53450 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 247 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53450 53502 NCCI NCCI Standards of medical / surgical practice 53450 53505 NCCI NCCI Standards of medical / surgical practice 53450 53510 NCCI NCCI Standards of medical / surgical practice 53450 53515 NCCI NCCI Standards of medical / surgical practice 53450 53520 NCCI NCCI Standards of medical / surgical practice 53450 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 64416 NCCI NCCI Refer to Specific Guidelines 53450 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53450 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 53450 90775 NCCI Standards of medical/surgical practice 53450 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53460 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 51701 NCCI Standards of medical / surgical practice 53460 51702 NCCI NCCI Refer to Specific Guidelines 53460 51703 NCCI Standards of medical/surgical practice 53460 52301 NCCI NCCI Sequential procedures 53460 53000 NCCI NCCI HCPCS/CPT separate procedure definition 53460 53010 NCCI NCCI HCPCS/CPT separate procedure definition 53460 53020 NCCI NCCI HCPCS/CPT separate procedure definition 53460 53025 NCCI NCCI HCPCS/CPT separate procedure definition 53460 53080 NCCI 53460 53460 BCBST 53460 53502 NCCI NCCI Standards of medical / surgical practice 53460 53505 NCCI NCCI Standards of medical / surgical practice 53460 53510 NCCI NCCI Standards of medical / surgical practice 53460 53515 NCCI NCCI Standards of medical / surgical practice 53460 53520 NCCI NCCI Standards of medical / surgical practice 53460 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 64416 NCCI NCCI Refer to Specific Guidelines 53460 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 248 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53460 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53460 90775 NCCI Standards of medical/surgical practice 53460 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53500 90775 NCCI Standards of medical/surgical practice 53500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53502 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 51701 NCCI NCCI Refer to Specific Guidelines 53502 51702 NCCI NCCI Refer to Specific Guidelines 53502 51703 NCCI Standards of medical/surgical practice 53502 52301 NCCI NCCI Sequential procedures 53502 53080 NCCI 53502 53502 BCBST 53502 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 64416 NCCI NCCI Refer to Specific Guidelines 53502 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53502 90775 NCCI Standards of medical/surgical practice 53502 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53505 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 51701 NCCI Standards of medical / surgical practice 53505 51702 NCCI NCCI Refer to Specific Guidelines 53505 51703 NCCI Standards of medical/surgical practice 53505 52301 NCCI NCCI Sequential procedures 53505 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53505 53502 NCCI NCCI Mutually exclusive procedures 53505 53505 BCBST 53505 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 64416 NCCI NCCI Refer to Specific Guidelines NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 249 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53505 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53505 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 53505 90775 NCCI Standards of medical/surgical practice 53505 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53510 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 51701 NCCI NCCI Refer to Specific Guidelines 53510 51702 NCCI NCCI Refer to Specific Guidelines 53510 51703 NCCI Standards of medical/surgical practice 53510 52301 NCCI NCCI Sequential procedures 53510 53080 NCCI 53510 53510 BCBST 53510 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 64416 NCCI NCCI Refer to Specific Guidelines 53510 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53510 90775 NCCI Standards of medical/surgical practice 53510 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53515 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 51701 NCCI Standards of medical / surgical practice 53515 51702 NCCI NCCI Refer to Specific Guidelines 53515 51703 NCCI Standards of medical/surgical practice 53515 52301 NCCI NCCI Sequential procedures 53515 53080 NCCI 53515 53515 BCBST 53515 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 64416 NCCI NCCI Refer to Specific Guidelines 53515 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition OB-GYN procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 250 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53515 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53515 90775 NCCI Standards of medical/surgical practice 53515 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 51701 NCCI Standards of medical / surgical practice 53520 51702 NCCI NCCI Refer to Specific Guidelines 53520 51703 NCCI Standards of medical/surgical practice 53520 52301 NCCI NCCI Sequential procedures 53520 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53520 53520 BCBST 53520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 64416 NCCI NCCI Refer to Specific Guidelines 53520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53520 NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. 69990 NCCI 53520 90775 NCCI Standards of medical/surgical practice 53520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 51701 NCCI NCCI Refer to Specific Guidelines 53600 51702 NCCI NCCI Refer to Specific Guidelines 53600 51703 NCCI Standards of medical/surgical practice 53600 53600 BCBST 53600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 64416 NCCI NCCI Refer to Specific Guidelines 53600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53600 90775 NCCI Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 251 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53600 J2001 NCCI Misuse of column 2 code with column 1 code 53600 P9612 NCCI NCCI Standards of medical / surgical practice 53600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53601 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 51701 NCCI NCCI Refer to Specific Guidelines 53601 51702 NCCI NCCI Refer to Specific Guidelines 53601 51703 NCCI Standards of medical/surgical practice 53601 53600 NCCI 53601 53601 BCBST 53601 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 64416 NCCI NCCI Refer to Specific Guidelines 53601 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53601 90775 NCCI Standards of medical/surgical practice 53601 J2001 NCCI Misuse of column 2 code with column 1 code 53601 P9612 NCCI NCCI Standards of medical / surgical practice 53601 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53605 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 51701 NCCI Standards of medical / surgical practice 53605 51702 NCCI NCCI Refer to Specific Guidelines 53605 51703 NCCI 53605 53605 BCBST 53605 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 64416 NCCI NCCI Refer to Specific Guidelines 53605 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53605 90775 NCCI Standards of medical/surgical practice NCCI Mutually exclusive procedures Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 252 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53605 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53620 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 51701 NCCI Standards of medical / surgical practice 53620 51702 NCCI NCCI Refer to Specific Guidelines 53620 51703 NCCI NCCI Refer to Specific Guidelines 53620 53620 BCBST 53620 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 64416 NCCI NCCI Refer to Specific Guidelines 53620 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53620 90775 NCCI Standards of medical/surgical practice 53620 J2001 NCCI Misuse of column 2 code with column 1 code 53620 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53621 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 51701 NCCI Standards of medical / surgical practice 53621 51702 NCCI NCCI Refer to Specific Guidelines 53621 51703 NCCI Standards of medical/surgical practice 53621 53620 NCCI NCCI Mutually exclusive procedures 53621 53621 BCBST 53621 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 64416 NCCI NCCI Refer to Specific Guidelines 53621 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53621 90775 NCCI Standards of medical/surgical practice 53621 J2001 NCCI Misuse of column 2 code with column 1 code 53621 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53660 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 253 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53660 51701 NCCI NCCI Refer to Specific Guidelines 53660 51702 NCCI NCCI Refer to Specific Guidelines 53660 51703 NCCI Standards of medical/surgical practice 53660 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53660 53660 BCBST 53660 53661 NCCI NCCI Mutually exclusive procedures 53660 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 64416 NCCI NCCI Refer to Specific Guidelines 53660 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53660 90775 NCCI Standards of medical/surgical practice OB-GYN procedure redundant to itself. 53660 J2001 NCCI Misuse of column 2 code with column 1 code 53660 P9612 NCCI NCCI Standards of medical / surgical practice 53660 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53661 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 51700 NCCI NCCI Standards of medical / surgical practice 53661 51701 NCCI NCCI Refer to Specific Guidelines 53661 51702 NCCI NCCI Refer to Specific Guidelines 53661 51703 NCCI Standards of medical/surgical practice 53661 53080 NCCI NCCI HCPCS/CPT separate procedure definition 53661 53661 BCBST 53661 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 64416 NCCI NCCI Refer to Specific Guidelines 53661 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53661 90775 NCCI Standards of medical/surgical practice OB-GYN procedure redundant to itself. 53661 J2001 NCCI Misuse of column 2 code with column 1 code 53661 P9612 NCCI NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 254 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53661 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53665 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 51701 NCCI NCCI Refer to Specific Guidelines 53665 51702 NCCI NCCI Refer to Specific Guidelines 53665 51703 NCCI Standards of medical/surgical practice 53665 53080 NCCI 53665 53660 BCBST OB-GYN redundant procedure. 53665 53661 BCBST OB-GYN redundant procedure. 53665 53665 BCBST OB-GYN procedure redundant to itself. 53665 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 64416 NCCI NCCI Refer to Specific Guidelines 53665 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53665 90775 NCCI Standards of medical/surgical practice 53665 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53850 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 51700 NCCI NCCI Standards of medical / surgical practice 53850 51701 NCCI NCCI Refer to Specific Guidelines 53850 51702 NCCI NCCI Refer to Specific Guidelines 53850 51703 NCCI NCCI Refer to Specific Guidelines 53850 52000 NCCI NCCI HCPCS/CPT separate procedure definition 53850 52001 NCCI NCCI Standards of medical / surgical practice 53850 52005 NCCI NCCI Standards of medical / surgical practice 53850 52276 NCCI NCCI Standards of medical / surgical practice 53850 52281 NCCI NCCI Standards of medical / surgical practice 53850 52630 NCCI Mutually exclusive procedures 53850 52640 NCCI Mutually exclusive procedures 53850 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53850 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53850 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53850 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53850 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 255 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53850 53850 BCBST Code redundant to self/should not be reported more than once due to standard description 53850 55700 NCCI NCCI Standards of medical / surgical practice 53850 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 64416 NCCI NCCI Refer to Specific Guidelines 53850 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53850 76872 NCCI Most extensive procedures 53850 76873 NCCI Misuse of Column 2 code with Column 1 code 53850 90775 NCCI Standards of medical/surgical practice 53850 J2001 NCCI Misuse of column 2 code with column 1 code 53850 P9612 NCCI NCCI Standards of medical / surgical practice 53850 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53852 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 51102 NCCI Standards of medical/surgical practice 53852 51700 NCCI NCCI Standards of medical / surgical practice 53852 51701 NCCI NCCI Refer to Specific Guidelines 53852 51702 NCCI NCCI Refer to Specific Guidelines 53852 51703 NCCI NCCI Refer to Specific Guidelines 53852 52000 NCCI NCCI HCPCS/CPT separate procedure definition 53852 52001 NCCI NCCI Standards of medical / surgical practice 53852 52281 NCCI NCCI Standards of medical / surgical practice 53852 52500 NCCI NCCI HCPCS/CPT separate procedure definition 53852 52630 NCCI Mutually exclusive procedures 53852 52640 NCCI Mutually exclusive procedures 53852 53600 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53852 53601 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53852 53605 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53852 53620 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53852 53621 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 53852 53850 NCCI 53852 53852 BCBST 53852 55700 NCCI Mutually exclusive procedures Code redundant to self/should not be reported more than once due to standard description NCCI Standards of medical / surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 256 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 53852 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 64416 NCCI NCCI Refer to Specific Guidelines 53852 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 53852 76872 NCCI Most extensive procedures 53852 76873 NCCI Misuse of Column 2 code with Column 1 code 53852 90775 NCCI Standards of medical/surgical practice 53852 J2001 NCCI Misuse of column 2 code with column 1 code 53852 P9612 NCCI NCCI Standards of medical / surgical practice 53852 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 53899 53899 BCBST 53899 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 51701 NCCI Standards of medical / surgical practice 54000 51702 NCCI NCCI Refer to Specific Guidelines 54000 51703 NCCI Standards of medical/surgical practice 54000 54000 BCBST 54000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 64416 NCCI NCCI Refer to Specific Guidelines 54000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54000 90775 NCCI Standards of medical/surgical practice 54000 J2001 NCCI Misuse of column 2 code with column 1 code 54000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54001 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 51701 NCCI Standards of medical / surgical practice 54001 51702 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 257 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54001 51703 NCCI 54001 54001 BCBST 54001 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 64416 NCCI NCCI Refer to Specific Guidelines 54001 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54001 90775 NCCI Standards of medical/surgical practice 54001 J2001 NCCI Misuse of column 2 code with column 1 code 54001 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54015 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 51701 NCCI Standards of medical / surgical practice 54015 51702 NCCI NCCI Refer to Specific Guidelines 54015 51703 NCCI Standards of medical/surgical practice 54015 54001 NCCI 54015 54015 BCBST Dermatology procedure redundant to itself. 54015 54105 BCBST Dermatology procedure -- standard subset procedure rationale. 54015 54450 NCCI NCCI Standards of medical / surgical practice 54015 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 64416 NCCI NCCI Refer to Specific Guidelines 54015 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54015 90775 NCCI Standards of medical/surgical practice 54015 J2001 NCCI Misuse of column 2 code with column 1 code 54015 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54050 16020 BCBST 54050 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 51701 NCCI Standards of medical / surgical practice 54050 51702 NCCI NCCI Refer to Specific Guidelines Standards of medical/surgical practice Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Dermatology procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 258 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54050 51703 NCCI Standards of medical/surgical practice 54050 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 64416 NCCI NCCI Refer to Specific Guidelines 54050 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54050 90775 NCCI Standards of medical/surgical practice 54050 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54055 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 51701 NCCI Standards of medical / surgical practice 54055 51702 NCCI NCCI Refer to Specific Guidelines 54055 51703 NCCI Standards of medical/surgical practice 54055 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 64416 NCCI NCCI Refer to Specific Guidelines 54055 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54055 90775 NCCI Standards of medical/surgical practice 54055 99211 CPT HCPCS/CPT coding manual instruction/guideline 54055 99212 CPT HCPCS/CPT coding manual instruction/guideline 54055 99213 CPT HCPCS/CPT coding manual instruction/guideline 54055 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54056 16020 BCBST 54056 37202 NCCI 54056 51701 NCCI Standards of medical / surgical practice 54056 51702 NCCI NCCI Refer to Specific Guidelines 54056 51703 NCCI Standards of medical/surgical practice 54056 54050 NCCI NCCI Mutually exclusive procedures 54056 54055 NCCI NCCI Mutually exclusive procedures 54056 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code Dermatology procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 259 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54056 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 64416 NCCI NCCI Refer to Specific Guidelines 54056 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54056 90775 NCCI Standards of medical/surgical practice 54056 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54057 16020 BCBST 54057 37202 NCCI 54057 51701 NCCI Standards of medical / surgical practice 54057 51702 NCCI NCCI Refer to Specific Guidelines 54057 51703 NCCI Standards of medical/surgical practice 54057 54050 NCCI NCCI Mutually exclusive procedures 54057 54055 NCCI NCCI Mutually exclusive procedures 54057 54056 NCCI NCCI Mutually exclusive procedures 54057 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 64416 NCCI NCCI Refer to Specific Guidelines 54057 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54057 90775 NCCI Standards of medical/surgical practice 54057 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54060 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54060 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54060 37202 NCCI 54060 51701 NCCI Standards of medical / surgical practice 54060 51702 NCCI NCCI Refer to Specific Guidelines 54060 51703 NCCI Standards of medical/surgical practice 54060 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code Dermatology procedure -- standard subset procedure rationale. NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 260 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54060 64416 NCCI NCCI Refer to Specific Guidelines 54060 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54060 90775 NCCI Standards of medical/surgical practice 54060 J2001 NCCI Misuse of column 2 code with column 1 code 54060 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54065 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54065 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54065 16030 BCBST Dermatology procedure -- standard subset procedure rationale. 54065 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 51701 NCCI Standards of medical / surgical practice 54065 51702 NCCI NCCI Refer to Specific Guidelines 54065 51703 NCCI Standards of medical/surgical practice 54065 54050 NCCI NCCI Most extensive procedures 54065 54055 NCCI NCCI Most extensive procedures 54065 54056 NCCI NCCI Most extensive procedures 54065 54057 NCCI NCCI Most extensive procedures 54065 54060 NCCI NCCI Most extensive procedures 54065 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 64416 NCCI NCCI Refer to Specific Guidelines 54065 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54065 90775 NCCI Standards of medical/surgical practice 54065 J2001 NCCI Misuse of column 2 code with column 1 code 54065 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54100 10021 NCCI NCCI Sequential procedures 54100 10022 NCCI 54100 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54100 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54100 37202 NCCI NCCI Sequential procedures NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 261 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54100 51701 NCCI Standards of medical / surgical practice 54100 51703 NCCI Standards of medical/surgical practice 54100 54001 NCCI NCCI HCPCS/CPT separate procedure definition 54100 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 64416 NCCI NCCI Refer to Specific Guidelines 54100 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54100 90775 NCCI Standards of medical/surgical practice 54100 J2001 NCCI Misuse of column 2 code with column 1 code 54100 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54105 10021 NCCI NCCI Sequential procedures 54105 10022 NCCI 54105 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54105 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54105 16030 BCBST Dermatology procedure -- standard subset procedure rationale. 54105 37202 NCCI 54105 51701 NCCI Standards of medical / surgical practice 54105 51702 NCCI NCCI Refer to Specific Guidelines 54105 51703 NCCI Standards of medical/surgical practice 54105 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54105 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 64416 NCCI NCCI Refer to Specific Guidelines 54105 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54105 90775 NCCI Standards of medical/surgical practice 54105 J2001 NCCI Misuse of column 2 code with column 1 code 54105 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54110 16020 BCBST NCCI Sequential procedures NCCI Misuse of Column 2 code with Column 1 code Dermatology procedure -- standard subset procedure rationale. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 262 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54110 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54110 16030 BCBST Dermatology procedure -- standard subset procedure rationale. 54110 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 51701 NCCI Standards of medical / surgical practice 54110 51702 NCCI NCCI Refer to Specific Guidelines 54110 51703 NCCI Standards of medical/surgical practice 54110 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54110 54105 NCCI NCCI Most extensive procedures 54110 54200 NCCI NCCI Standards of medical / surgical practice 54110 54205 NCCI NCCI Standards of medical / surgical practice 54110 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 64416 NCCI NCCI Refer to Specific Guidelines 54110 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54110 90775 NCCI Standards of medical/surgical practice 54110 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54111 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54111 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54111 16030 BCBST Dermatology procedure -- standard subset procedure rationale. 54111 37202 NCCI 54111 51701 NCCI Standards of medical / surgical practice 54111 51702 NCCI NCCI Refer to Specific Guidelines 54111 51703 NCCI Standards of medical/surgical practice 54111 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54111 54105 NCCI NCCI Standards of medical / surgical practice 54111 54110 NCCI NCCI Most extensive procedures 54111 54115 NCCI NCCI Standards of medical / surgical practice 54111 54200 NCCI NCCI Standards of medical / surgical practice 54111 54205 NCCI NCCI Standards of medical / surgical practice 54111 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 64416 NCCI NCCI Refer to Specific Guidelines NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 263 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54111 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54111 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 54111 90775 NCCI Standards of medical/surgical practice 54111 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54112 16020 BCBST Dermatology procedure -- standard subset procedure rationale. 54112 16025 BCBST Dermatology procedure -- standard subset procedure rationale. 54112 16030 BCBST Dermatology procedure -- standard subset procedure rationale. 54112 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 51701 NCCI Standards of medical / surgical practice 54112 51702 NCCI NCCI Refer to Specific Guidelines 54112 51703 NCCI Standards of medical/surgical practice 54112 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54112 54105 NCCI NCCI Standards of medical / surgical practice 54112 54110 NCCI NCCI Most extensive procedures 54112 54115 NCCI NCCI Standards of medical / surgical practice 54112 54200 NCCI NCCI Standards of medical / surgical practice 54112 54205 NCCI NCCI Standards of medical / surgical practice 54112 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 64416 NCCI NCCI Refer to Specific Guidelines 54112 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54112 90775 NCCI Standards of medical/surgical practice 54112 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54115 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 51701 NCCI Standards of medical / surgical practice 54115 51702 NCCI NCCI Refer to Specific Guidelines 54115 51703 NCCI Standards of medical/surgical practice 54115 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54115 54105 BCBST 54115 54110 NCCI Dermatology procedure -- standard subset procedure rationale. NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 264 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54115 54115 BCBST Dermatology procedure redundant to itself. 54115 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 64416 NCCI NCCI Refer to Specific Guidelines 54115 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54115 90775 NCCI Standards of medical/surgical practice 54115 J2001 NCCI Misuse of column 2 code with column 1 code 54115 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54120 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 51701 NCCI Standards of medical / surgical practice 54120 51702 NCCI NCCI Refer to Specific Guidelines 54120 51703 NCCI Standards of medical/surgical practice 54120 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54120 54105 NCCI NCCI Most extensive procedures 54120 54110 NCCI NCCI Most extensive procedures 54120 54111 NCCI NCCI Most extensive procedures 54120 54112 NCCI NCCI Most extensive procedures 54120 54115 NCCI NCCI Most extensive procedures 54120 54120 BCBST 54120 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 64416 NCCI NCCI Refer to Specific Guidelines 54120 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54120 90775 NCCI Standards of medical/surgical practice 54120 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54125 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 51701 NCCI Standards of medical / surgical practice 54125 51702 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 265 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54125 51703 NCCI Standards of medical/surgical practice 54125 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54125 54105 NCCI NCCI Most extensive procedures 54125 54110 NCCI NCCI Most extensive procedures 54125 54111 NCCI NCCI Most extensive procedures 54125 54112 NCCI NCCI Most extensive procedures 54125 54115 NCCI NCCI Most extensive procedures 54125 54120 NCCI 54125 54125 BCBST 54125 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 64416 NCCI NCCI Refer to Specific Guidelines 54125 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54125 90775 NCCI Standards of medical/surgical practice 54125 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54130 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 38760 NCCI NCCI HCPCS/CPT procedure code definition 54130 51701 NCCI Standards of medical / surgical practice 54130 51702 NCCI NCCI Refer to Specific Guidelines 54130 51703 NCCI Standards of medical/surgical practice 54130 54100 NCCI 54130 54130 BCBST 54130 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 64416 NCCI NCCI Refer to Specific Guidelines 54130 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54130 90775 NCCI Standards of medical/surgical practice NCCI HCPCS/CPT procedure code definition Procedure redundant to itself. NCCI HCPCS/CPT separate procedure definition Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 266 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54130 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54135 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 38571 NCCI NCCI Most extensive procedures 54135 38572 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 38765 NCCI NCCI HCPCS/CPT procedure code definition 54135 51701 NCCI Standards of medical / surgical practice 54135 51702 NCCI NCCI Refer to Specific Guidelines 54135 51703 NCCI Standards of medical/surgical practice 54135 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54135 54135 BCBST 54135 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 64416 NCCI NCCI Refer to Specific Guidelines 54135 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54135 NCCI Misuse of Column 2 code with Column 1 code Code redundant to self/should not be reported more than once due to standard description 69990 NCCI 54135 90775 NCCI Standards of medical/surgical practice 54135 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54150 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 51701 NCCI Standards of medical / surgical practice 54150 51702 NCCI NCCI Refer to Specific Guidelines 54150 51703 NCCI Standards of medical/surgical practice 54150 54000 NCCI NCCI HCPCS/CPT separate procedure definition 54150 54001 NCCI NCCI HCPCS/CPT separate procedure definition 54150 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54150 54150 BCBST Procedure redundant to itself. 54150 54164 BCBST NCCI CPT/HCPCS coding manual instruction / guideline 54150 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 64416 NCCI NCCI Refer to Specific Guidelines 54150 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 267 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54150 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54150 90775 NCCI Standards of medical/surgical practice 54150 J2001 NCCI Misuse of column 2 code with column 1 code 54150 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54160 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 51701 NCCI Standards of medical / surgical practice 54160 51702 NCCI NCCI Refer to Specific Guidelines 54160 51703 NCCI Standards of medical/surgical practice 54160 54000 NCCI NCCI HCPCS/CPT separate procedure definition 54160 54001 NCCI NCCI HCPCS/CPT separate procedure definition 54160 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54160 54160 BCBST Procedure redundant to itself. 54160 54164 BCBST NCCI CPT/HCPCS coding manual instruction / guideline 54160 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 64416 NCCI NCCI Refer to Specific Guidelines 54160 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54160 90775 NCCI Standards of medical/surgical practice 54160 J2001 NCCI Misuse of column 2 code with column 1 code 54160 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54161 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 51701 NCCI Standards of medical / surgical practice 54161 51702 NCCI NCCI Refer to Specific Guidelines 54161 51703 NCCI Standards of medical/surgical practice 54161 54000 NCCI NCCI HCPCS/CPT separate procedure definition 54161 54001 NCCI NCCI HCPCS/CPT separate procedure definition 54161 54100 NCCI NCCI HCPCS/CPT separate procedure definition 54161 54161 BCBST 54161 54164 NCCI 54161 54450 NCCI NCCI Standards of medical / surgical practice 54161 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI HCPCS/CPT coding manual instruction / guideline CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 268 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54161 64416 NCCI NCCI Refer to Specific Guidelines 54161 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54161 90775 NCCI Standards of medical/surgical practice 54161 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54162 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 51701 NCCI Standards of medical / surgical practice 54162 51702 NCCI NCCI Refer to Specific Guidelines 54162 51703 NCCI Standards of medical/surgical practice 54162 54000 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54162 54001 BCBST Edited code not allowed when used to report incidental slitting of prepuce at the time of the definitive procedure. 54162 54050 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54055 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54056 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54057 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54060 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54065 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54162 54100 BCBST Edited code not allowed when used to report incidental biopsy done at the time of the definitive procedure. 54162 54150 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54162 54160 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54162 54161 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. 54162 54162 BCBST Procedure redundant to itself. 54162 54164 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental frenulotomy at the time of the definitive procedure. 54162 54450 BCBST Edited code not allowed when used to report incidental foreskin manipulation at the time of the definitive procedure. 54162 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 269 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54162 64416 NCCI NCCI Refer to Specific Guidelines 54162 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54162 69990 BCBST 54162 90775 NCCI Standards of medical/surgical practice 54162 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54163 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 51701 NCCI Standards of medical / surgical practice 54163 51702 NCCI NCCI Refer to Specific Guidelines 54163 51703 NCCI Standards of medical/surgical practice 54163 54000 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54163 54001 BCBST Edited code not allowed when used to report incidental slitting of prepuce at the time of the definitive procedure. 54163 54050 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54055 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54056 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54057 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54060 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54065 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54163 54100 BCBST Edited code not allowed when used to report incidental biopsy done at the time of the definitive procedure. 54163 54150 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54163 54160 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54163 54161 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. 54163 54162 BCBST Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54163 54163 BCBST Procedure redundant to itself. 54163 54164 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental frenulotomy at the time of the definitive procedure. 54163 54450 BCBST Edited code not allowed when used to report incidental foreskin manipulation at the time of the definitive procedure. Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 270 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54163 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 64416 NCCI NCCI Refer to Specific Guidelines 54163 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54163 64475 NCCI 54163 69990 BCBST 54163 90775 NCCI Standards of medical/surgical practice 54163 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54164 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 51701 NCCI Standards of medical / surgical practice 54164 51702 NCCI NCCI Refer to Specific Guidelines 54164 51703 NCCI Standards of medical/surgical practice 54164 54000 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54164 54001 BCBST Edited code not allowed when used to report incidental slitting of prepuce at the time of the definitive procedure. 54164 54050 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54055 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54056 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54057 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54060 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54065 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54164 54100 BCBST Edited code not allowed when used to report incidental biopsy done at the time of the definitive procedure. 54164 54150 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54164 54160 BCBST Incompatible code combination or component. Listed procedure is performed on non-newborn patients. 54164 54161 BCBST Clinically incompatible code combination or component. Review before reimbursing the edited code. 54164 54164 BCBST Procedure redundant to itself. 54164 54450 BCBST Edited code not allowed when used to report incidental foreskin manipulation at the time of the definitive procedure. 54164 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 271 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54164 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 64416 NCCI NCCI Refer to Specific Guidelines 54164 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54164 69990 BCBST 54164 90775 NCCI Standards of medical/surgical practice 54164 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 51701 NCCI Standards of medical / surgical practice 54200 51702 NCCI NCCI Refer to Specific Guidelines 54200 51703 NCCI Standards of medical/surgical practice 54200 54200 BCBST 54200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 64416 NCCI NCCI Refer to Specific Guidelines 54200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54200 90775 NCCI Standards of medical/surgical practice 54200 J2001 NCCI Misuse of column 2 code with column 1 code 54200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54205 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 51701 NCCI Standards of medical / surgical practice 54205 51702 NCCI NCCI Refer to Specific Guidelines 54205 51703 NCCI Standards of medical/surgical practice 54205 54200 NCCI 54205 54205 BCBST 54205 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 64416 NCCI NCCI Refer to Specific Guidelines Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Procedure redundant to itself. NCCI HCPCS/CPT procedure code definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 272 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54205 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54205 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 54205 90775 NCCI Standards of medical/surgical practice 54205 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 51701 NCCI Standards of medical / surgical practice 54220 51702 NCCI NCCI Refer to Specific Guidelines 54220 51703 NCCI Standards of medical/surgical practice 54220 54220 BCBST 54220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 64416 NCCI NCCI Refer to Specific Guidelines 54220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54220 90775 NCCI Standards of medical/surgical practice 54220 J2001 NCCI Misuse of column 2 code with column 1 code 54220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54230 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 51701 NCCI Standards of medical / surgical practice 54230 51702 NCCI NCCI Refer to Specific Guidelines 54230 51703 NCCI Standards of medical/surgical practice 54230 54230 BCBST 54230 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 64416 NCCI NCCI Refer to Specific Guidelines 54230 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54230 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 273 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54230 90775 NCCI Standards of medical/surgical practice 54230 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54231 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 51701 NCCI Standards of medical / surgical practice 54231 51702 NCCI NCCI Refer to Specific Guidelines 54231 51703 NCCI Standards of medical/surgical practice 54231 54235 NCCI NCCI Standards of medical / surgical practice 54231 54240 NCCI NCCI Standards of medical / surgical practice 54231 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 64416 NCCI NCCI Refer to Specific Guidelines 54231 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54231 90775 NCCI Standards of medical/surgical practice 54231 J2001 NCCI Misuse of column 2 code with column 1 code 54231 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54235 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 51701 NCCI Standards of medical / surgical practice 54235 51702 NCCI NCCI Refer to Specific Guidelines 54235 51703 NCCI 54235 54235 BCBST 54235 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 64416 NCCI NCCI Refer to Specific Guidelines 54235 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54235 90775 NCCI Standards of medical/surgical practice 54235 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 274 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54240 51701 NCCI Standards of medical / surgical practice 54240 51702 NCCI NCCI Refer to Specific Guidelines 54240 51703 NCCI 54240 54240 BCBST 54240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 64416 NCCI NCCI Refer to Specific Guidelines 54240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54240 90775 NCCI Standards of medical/surgical practice 54240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54250 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 51701 NCCI Standards of medical / surgical practice 54250 51702 NCCI NCCI Refer to Specific Guidelines 54250 51703 NCCI 54250 54250 BCBST 54250 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 64416 NCCI NCCI Refer to Specific Guidelines 54250 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54250 90775 NCCI Standards of medical/surgical practice 54250 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 51701 NCCI Standards of medical / surgical practice 54300 51702 NCCI NCCI Refer to Specific Guidelines 54300 51703 NCCI 54300 54300 BCBST 54300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 275 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 64416 NCCI NCCI Refer to Specific Guidelines 54300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54300 90775 NCCI Standards of medical/surgical practice 54300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54304 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 51701 NCCI Standards of medical / surgical practice 54304 51702 NCCI NCCI Refer to Specific Guidelines 54304 51703 NCCI Standards of medical/surgical practice 54304 54300 NCCI NCCI Most extensive procedures 54304 54304 BCBST 54304 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 64416 NCCI NCCI Refer to Specific Guidelines 54304 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54304 90775 NCCI Standards of medical/surgical practice 54304 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54308 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 51701 NCCI Standards of medical / surgical practice 54308 51702 NCCI NCCI Refer to Specific Guidelines 54308 51703 NCCI Standards of medical/surgical practice 54308 54308 BCBST 54308 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 64416 NCCI NCCI Refer to Specific Guidelines 54308 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 276 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54308 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54308 90775 NCCI Standards of medical/surgical practice 54308 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54312 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 51701 NCCI Standards of medical / surgical practice 54312 51702 NCCI NCCI Refer to Specific Guidelines 54312 51703 NCCI 54312 54312 BCBST 54312 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 64416 NCCI NCCI Refer to Specific Guidelines 54312 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54312 90775 NCCI Standards of medical/surgical practice 54312 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54316 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 51701 NCCI Standards of medical / surgical practice 54316 51702 NCCI NCCI Refer to Specific Guidelines 54316 51703 NCCI 54316 54316 BCBST 54316 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 64416 NCCI NCCI Refer to Specific Guidelines 54316 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54316 90775 NCCI Standards of medical/surgical practice 54316 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54318 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Code redundant to self/should not be reported more than once due to standard description CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 277 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54318 51701 NCCI Standards of medical / surgical practice 54318 51702 NCCI NCCI Refer to Specific Guidelines 54318 51703 NCCI 54318 54318 BCBST 54318 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 64416 NCCI NCCI Refer to Specific Guidelines 54318 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54318 90775 NCCI Standards of medical/surgical practice 54318 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54322 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 51701 NCCI Standards of medical / surgical practice 54322 51702 NCCI NCCI Refer to Specific Guidelines 54322 51703 NCCI 54322 54322 BCBST 54322 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 64416 NCCI NCCI Refer to Specific Guidelines 54322 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54322 90775 NCCI Standards of medical/surgical practice 54322 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54324 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 51701 NCCI Standards of medical / surgical practice 54324 51702 NCCI NCCI Refer to Specific Guidelines 54324 51703 NCCI 54324 54324 BCBST 54324 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 278 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54324 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 64416 NCCI NCCI Refer to Specific Guidelines 54324 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54324 90775 NCCI Standards of medical/surgical practice 54324 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54326 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 51701 NCCI Standards of medical / surgical practice 54326 51702 NCCI NCCI Refer to Specific Guidelines 54326 51703 NCCI Standards of medical/surgical practice 54326 54324 NCCI NCCI HCPCS/CPT procedure code definition 54326 54326 BCBST 54326 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 64416 NCCI NCCI Refer to Specific Guidelines 54326 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54326 90775 NCCI Standards of medical/surgical practice 54326 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54328 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 51701 NCCI Standards of medical / surgical practice 54328 51702 NCCI NCCI Refer to Specific Guidelines 54328 51703 NCCI Standards of medical/surgical practice 54328 54326 NCCI 54328 54328 BCBST 54328 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 64416 NCCI NCCI Refer to Specific Guidelines 54328 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. NCCI Mutually exclusive procedures Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 279 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54328 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54328 90775 NCCI Standards of medical/surgical practice 54328 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54332 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 51701 NCCI Standards of medical / surgical practice 54332 51702 NCCI NCCI Refer to Specific Guidelines 54332 51703 NCCI Standards of medical/surgical practice 54332 54332 BCBST 54332 54352 NCCI NCCI Mutually exclusive procedures 54332 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 64416 NCCI NCCI Refer to Specific Guidelines 54332 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54332 90775 NCCI Standards of medical/surgical practice 54332 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54336 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 51701 NCCI Standards of medical / surgical practice 54336 51702 NCCI NCCI Refer to Specific Guidelines 54336 51703 NCCI 54336 54336 BCBST 54336 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 64416 NCCI NCCI Refer to Specific Guidelines 54336 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54336 90775 NCCI Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 280 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54336 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54340 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 51701 NCCI Standards of medical / surgical practice 54340 51702 NCCI NCCI Refer to Specific Guidelines 54340 51703 NCCI Standards of medical/surgical practice 54340 54340 BCBST 54340 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 64416 NCCI NCCI Refer to Specific Guidelines 54340 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54340 90775 NCCI Standards of medical/surgical practice 54340 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54344 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 51701 NCCI Standards of medical / surgical practice 54344 51702 NCCI NCCI Refer to Specific Guidelines 54344 51703 NCCI Standards of medical/surgical practice 54344 54344 BCBST 54344 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 64416 NCCI NCCI Refer to Specific Guidelines 54344 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54344 90775 NCCI Standards of medical/surgical practice 54344 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54348 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 51701 NCCI Standards of medical / surgical practice 54348 51702 NCCI NCCI Refer to Specific Guidelines 54348 51703 NCCI Standards of medical/surgical practice Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 281 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54348 54348 BCBST Procedure redundant to itself. 54348 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 64416 NCCI NCCI Refer to Specific Guidelines 54348 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54348 90775 NCCI Standards of medical/surgical practice 54348 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54352 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 51701 NCCI Standards of medical / surgical practice 54352 51702 NCCI NCCI Refer to Specific Guidelines 54352 51703 NCCI Standards of medical/surgical practice 54352 54352 BCBST 54352 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 64416 NCCI NCCI Refer to Specific Guidelines 54352 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54352 90775 NCCI Standards of medical/surgical practice 54352 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54360 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 51701 NCCI Standards of medical / surgical practice 54360 51702 NCCI NCCI Refer to Specific Guidelines 54360 51703 NCCI Standards of medical/surgical practice 54360 54360 BCBST 54360 54440 NCCI NCCI Mutually exclusive procedures 54360 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 64416 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 282 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54360 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54360 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 54360 90775 NCCI Standards of medical/surgical practice 54360 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54380 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 51701 NCCI Standards of medical / surgical practice 54380 51702 NCCI NCCI Refer to Specific Guidelines 54380 51703 NCCI Standards of medical/surgical practice 54380 54110 NCCI NCCI Most extensive procedures 54380 54111 NCCI NCCI Most extensive procedures 54380 54112 NCCI NCCI Most extensive procedures 54380 54200 NCCI NCCI Standards of medical / surgical practice 54380 54205 NCCI NCCI Standards of medical / surgical practice 54380 54380 BCBST 54380 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 64416 NCCI NCCI Refer to Specific Guidelines 54380 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54380 90775 NCCI Standards of medical/surgical practice 54380 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54385 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 51701 NCCI Standards of medical / surgical practice 54385 51702 NCCI NCCI Refer to Specific Guidelines 54385 51703 NCCI Standards of medical/surgical practice 54385 54380 NCCI 54385 54385 BCBST 54385 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 64416 NCCI NCCI Refer to Specific Guidelines Procedure redundant to itself. NCCI HCPCS/CPT procedure code definition Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 283 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54385 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54385 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 54385 90775 NCCI Standards of medical/surgical practice 54385 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54390 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 51701 NCCI Standards of medical / surgical practice 54390 51702 NCCI NCCI Refer to Specific Guidelines 54390 51703 NCCI Standards of medical/surgical practice 54390 51940 NCCI NCCI Standards of medical / surgical practice 54390 54380 NCCI 54390 54390 BCBST 54390 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 64416 NCCI NCCI Refer to Specific Guidelines 54390 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54390 90775 NCCI Standards of medical/surgical practice 54390 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 51701 NCCI Standards of medical / surgical practice 54400 51702 NCCI NCCI Refer to Specific Guidelines 54400 51703 NCCI Standards of medical/surgical practice 54400 54161 NCCI NCCI Standards of medical / surgical practice 54400 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54400 54400 BCBST Procedure redundant to itself. 54400 54401 NCCI 54400 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54400 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54400 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. NCCI HCPCS/CPT procedure code definition Procedure redundant to itself. NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 284 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54400 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54400 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 64416 NCCI NCCI Refer to Specific Guidelines 54400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54400 90775 NCCI Standards of medical/surgical practice 54400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54401 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 51701 NCCI Standards of medical / surgical practice 54401 51702 NCCI NCCI Refer to Specific Guidelines 54401 51703 NCCI 54401 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54401 54401 BCBST Procedure redundant to itself. 54401 54405 NCCI 54401 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54401 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54401 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54401 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54401 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54401 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 64416 NCCI NCCI Refer to Specific Guidelines 54401 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54401 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice NCCI Mutually exclusive procedures CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 285 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54401 90775 NCCI Standards of medical/surgical practice 54401 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54405 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 49000 NCCI NCCI Standards of medical / surgical practice 54405 49002 NCCI NCCI Standards of medical / surgical practice 54405 49010 NCCI NCCI Standards of medical / surgical practice 54405 51701 NCCI NCCI Refer to Specific Guidelines 54405 51702 NCCI NCCI Refer to Specific Guidelines 54405 51703 NCCI Standards of medical/surgical practice 54405 54110 NCCI NCCI Standards of medical / surgical practice 54405 54161 NCCI NCCI Standards of medical / surgical practice 54405 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54405 54405 BCBST Procedure redundant to itself. 54405 54408 NCCI 54405 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54405 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54405 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54405 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54405 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54405 62270 NCCI NCCI Anesthesia included in surgical procedures 54405 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 64416 NCCI NCCI Refer to Specific Guidelines 54405 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54405 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code 54405 90775 NCCI Standards of medical/surgical practice 54405 P9612 NCCI NCCI Standards of medical / surgical practice 54405 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54406 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 286 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54406 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54406 37202 NCCI 54406 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54406 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54406 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54406 51701 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 287 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54406 51702 NCCI NCCI Refer to Specific Guidelines 54406 51703 NCCI Standards of medical/surgical practice 54406 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54406 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54406 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54406 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54406 54400 BCBST Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54406 54401 BCBST Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54406 54405 BCBST NCCI HCPCS/CPT procedure code definition / Code combination rebundles to 54410. 54406 54405 BCBST NCCI HCPCS/CPT procedure code definition / Code combination rebundles to 54410. 54406 54405 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54406 54405 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54406 54406 BCBST Procedure redundant to itself. 54406 54408 BCBST Incompatible code combination or component. 54406 54415 BCBST Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54406 54416 NCCI 54406 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54406 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54406 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54406 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54406 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54406 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 64416 NCCI NCCI Refer to Specific Guidelines 54406 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 288 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54406 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54406 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 54406 90775 NCCI 54406 P9612 BCBST 54406 S0020 CPT 54408 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 289 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54408 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54408 37202 NCCI 54408 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54408 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54408 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54408 51701 NCCI NCCI Refer to Specific Guidelines 54408 51702 NCCI NCCI Refer to Specific Guidelines 54408 51703 NCCI Standards of medical/surgical practice 54408 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54408 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54408 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54408 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54408 54400 BCBST NCCI Misuse of Column 2 code with Column 1 code / The edited code is incompatible with the listed procedure in that it describes an alternative procedure that is exclusive of the listed procedure. 54408 54401 BCBST NCCI Misuse of Column 2 code with Column 1 code / The edited code is incompatible with the listed procedure in that it describes an alternative procedure that is exclusive of the listed procedure. 54408 54406 NCCI 54408 54408 BCBST 54408 54416 NCCI 54408 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54408 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54408 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54408 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54408 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54408 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code NCCI Most extensive procedures Procedure redundant to itself. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 290 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54408 64416 NCCI NCCI Refer to Specific Guidelines 54408 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54408 69990 BCBST 54408 90775 NCCI 54408 P9612 BCBST 54408 S0020 CPT 54410 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 291 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54410 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54410 37202 NCCI 54410 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54410 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54410 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54410 51701 NCCI NCCI Refer to Specific Guidelines 54410 51702 NCCI NCCI Refer to Specific Guidelines 54410 51703 NCCI Standards of medical/surgical practice 54410 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54410 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54410 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54410 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54410 54400 BCBST NCCI Misuse of Column 2 code with Column 1 code / Clinically incompatible code combination or component. Review before reimbursing the edited code. 54410 54401 BCBST NCCI Misuse of Column 2 code with Column 1 code / Clinically incompatible code combination or component. Review before reimbursing the edited code. 54410 54405 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54410 54406 NCCI 54410 54408 BCBST NCCI Most extensive procedures / Clinically incompatible code combination or component. Review before reimbursing the edited code. 54410 54410 BCBST Procedure redundant to itself. 54410 54415 BCBST NCCI Misuse of Column 2 code with Column 1 code / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54410 54416 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54410 54417 NCCI 54410 54440 BCBST NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines NCCI Misuse of Column 2 code with Column 1 code Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 292 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54410 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54410 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54410 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54410 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54410 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 64416 NCCI NCCI Refer to Specific Guidelines 54410 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54410 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 54410 90775 NCCI 54410 P9612 BCBST 54410 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54411 11004 NCCI Misuse of column 2 code with column 1 code 54411 11005 NCCI Misuse of column 2 code with column 1 code 54411 11006 NCCI 54411 11040 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54411 11041 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54411 11042 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54411 11043 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54411 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 293 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54411 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54411 37202 NCCI 54411 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54411 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54411 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54411 51701 NCCI NCCI Refer to Specific Guidelines 54411 51702 NCCI NCCI Refer to Specific Guidelines 54411 51703 NCCI Standards of medical/surgical practice 54411 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54411 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 294 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54411 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54411 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54411 54400 BCBST NCCI Misuse of Column 2 code with Column 1 code / The edited code is incompatible with the listed code in that it specifies an alternative device. Depending on device and the procedure performed, the listed code or the edited code, but not both, should be used. 54411 54401 BCBST NCCI Misuse of Column 2 code with Column 1 code / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54405 NCCI 54411 54405 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54405 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54406 NCCI 54411 54406 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54406 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54408 BCBST NCCI Most extensive procedures / The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54410 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54411 54411 BCBST Procedure redundant to itself. 54411 54415 BCBST NCCI Misuse of Column 2 code with Column 1 code / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54411 54416 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54411 54417 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54411 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54411 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54411 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54411 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54411 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54411 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 295 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54411 64416 NCCI NCCI Refer to Specific Guidelines 54411 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54411 69990 BCBST 54411 90775 NCCI 54411 P9612 BCBST 54411 S0020 CPT 54415 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 296 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54415 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54415 37202 NCCI 54415 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54415 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54415 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54415 51701 NCCI NCCI Refer to Specific Guidelines 54415 51702 NCCI NCCI Refer to Specific Guidelines 54415 51703 NCCI Standards of medical/surgical practice 54415 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54415 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54415 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54415 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54415 54400 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54400 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54400 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54400 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54401 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54401 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54401 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 297 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54415 54401 BCBST NCCI HCPCS/CPT procedure code definition / Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54405 BCBST Incompatible combination of codes. A more global CPT code may be appropriate for reporting the combined services of the listed and edited procedures. 54415 54408 BCBST The edited code is incompatible with the listed procedure in that it describes an alternative procedure that is exclusive of the listed procedure. 54415 54415 BCBST Procedure redundant to itself. 54415 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54415 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54415 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54415 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54415 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54415 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 64416 NCCI NCCI Refer to Specific Guidelines 54415 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54415 64475 NCCI 54415 69990 BCBST 54415 90775 NCCI 54415 P9612 BCBST 54415 S0020 CPT 54416 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 298 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54416 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54416 37202 NCCI 54416 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54416 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54416 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54416 51701 NCCI NCCI Refer to Specific Guidelines 54416 51702 NCCI NCCI Refer to Specific Guidelines 54416 51703 NCCI Standards of medical/surgical practice 54416 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54416 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54416 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 299 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54416 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54416 54400 NCCI 54416 54400 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54416 54400 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54416 54401 NCCI 54416 54401 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54416 54401 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54416 54405 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54416 54405 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54416 54405 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54416 54405 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54416 54406 BCBST Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54416 54408 BCBST The edited code is incompatible with the listed procedure in that it describes an alternative procedure that is exclusive of the listed procedure. 54416 54415 NCCI 54416 54416 BCBST Procedure redundant to itself. 54416 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54416 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54416 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54416 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54416 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54416 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 64416 NCCI NCCI Refer to Specific Guidelines 54416 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines NCCI Refer to Specific Guidelines NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 300 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54416 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54416 69990 BCBST Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. 54416 90775 NCCI 54416 P9612 BCBST 54416 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54417 11004 NCCI Misuse of column 2 code with column 1 code 54417 11005 NCCI Misuse of column 2 code with column 1 code 54417 11006 NCCI 54417 11040 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54417 11041 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54417 11042 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54417 11043 BCBST NCCI HCPCS/CPT coding manual instruction / guideline / Edited code not allowed when used to report incidental debridement at the time of the definitive procedure. 54417 12001 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12002 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12004 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12005 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12006 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12007 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12031 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12032 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12034 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12035 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12036 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12037 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12041 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. Misuse of column 2 code with column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 301 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54417 12042 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12044 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12045 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12046 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 12047 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 13131 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 13132 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 13133 BCBST Edited code not allowed when used to report the closure of the wound or repair of the tissues divided for initial surgical exposure. 54417 37202 NCCI 54417 49000 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54417 49002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54417 49010 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. Similar listed codes with edit disallowed according to NCCI CPT separate procedure definition. 54417 51701 NCCI NCCI Refer to Specific Guidelines 54417 51702 NCCI NCCI Refer to Specific Guidelines 54417 51703 NCCI 54417 54110 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. 54417 54115 BCBST Edited code not allowed if used to report incidental removal of the prosthesis or components included in the listed procedure. 54417 54161 BCBST Clinically unlikely code combination or component. Review before reimbursing the edited code. Experience has demonstrated that the edited code is often reported inappropriately in circumstances when the procedure was not performed, not medically indicated, or required minimal additional effort. 54417 54360 BCBST Edited code not allowed if used to report incidental plastic repair of penis for alignment included in the listed procedure. 54417 54400 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54400 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54400 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54400 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. NCCI Misuse of Column 2 code with Column 1 code Standards of medical/surgical practice CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 302 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54417 54401 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54401 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54401 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54401 BCBST NCCI HCPCS/CPT procedure code definition / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54405 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54406 BCBST NCCI Misuse of Column 2 code with Column 1 code / Procedure redundant to a portion of the listed procedure in that it describes essentially a component of the listed procedure with an incompatible variation or only a minor variation. 54417 54408 BCBST NCCI Misuse of Column 2 code with Column 1 code / The edited code is incompatible with the listed procedure in that it describes an alternative procedure that is exclusive of the listed procedure. 54417 54410 BCBST Procedure redundant to the listed procedure in that it describes essentially the same procedure with an incompatible variation or only a minor variation. 54417 54415 NCCI 54417 54415 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54417 54415 BCBST NCCI HCPCS/CPT procedure code definition / The edited code is a component of the listed code when performed as part of the listed procedure. 54417 54416 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 54417 54417 BCBST Procedure redundant to itself. 54417 54440 BCBST Edited code not allowed if used to report incidental plastic repair of penis included in the listed procedure. 54417 55110 BCBST Edited code not allowed if used to report incidental scrotal exploration included in the listed procedure. 54417 55120 BCBST Edited code not allowed if used to report incidental prosthesis or component removal included in the listed procedure. 54417 55175 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54417 55180 BCBST Edited code not allowed if used to report incidental scrotoplasty included in the listed procedure. 54417 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54417 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54417 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54417 64416 NCCI NCCI Refer to Specific Guidelines 54417 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54417 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54417 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Refer to Specific Guidelines CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 303 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54417 64475 NCCI 54417 69990 BCBST 54417 90775 NCCI 54417 P9612 BCBST 54417 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 51701 NCCI Standards of medical / surgical practice 54420 51702 NCCI NCCI Refer to Specific Guidelines 54420 51703 NCCI 54420 54420 BCBST 54420 54430 NCCI NCCI Standards of medical / surgical practice 54420 54435 NCCI NCCI Standards of medical / surgical practice 54420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 64416 NCCI NCCI Refer to Specific Guidelines 54420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54420 90775 NCCI Standards of medical/surgical practice 54420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54430 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 51701 NCCI Standards of medical / surgical practice 54430 51702 NCCI NCCI Refer to Specific Guidelines 54430 51703 NCCI 54430 54430 BCBST 54430 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 64416 NCCI NCCI Refer to Specific Guidelines 54430 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Misuse of Column 2 code with Column 1 code Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. Standards of medical/surgical practice Edited code not allowed when used to report incidental catheterization, with or without specimen collection, at the time of the definitive procedure. Standards of medical/surgical practice Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 304 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54430 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54430 90775 NCCI Standards of medical/surgical practice 54430 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54435 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 51701 NCCI Standards of medical / surgical practice 54435 51702 NCCI NCCI Refer to Specific Guidelines 54435 51703 NCCI Standards of medical/surgical practice 54435 54430 NCCI 54435 54435 BCBST 54435 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 64416 NCCI NCCI Refer to Specific Guidelines 54435 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54435 90775 NCCI Standards of medical/surgical practice 54435 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54440 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 51701 NCCI Standards of medical / surgical practice 54440 51702 NCCI NCCI Refer to Specific Guidelines 54440 51703 NCCI 54440 54440 BCBST 54440 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 64416 NCCI NCCI Refer to Specific Guidelines 54440 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54440 90775 NCCI Standards of medical/surgical practice 54440 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54450 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI Mutually exclusive procedures Procedure redundant to itself. Standards of medical/surgical practice Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 305 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54450 51701 NCCI Standards of medical/surgical practice 54450 51702 NCCI Standards of medical/surgical practice 54450 51703 NCCI Standards of medical/surgical practice 54450 54000 NCCI NCCI HCPCS/CPT separate procedure definition 54450 54001 NCCI NCCI HCPCS/CPT separate procedure definition 54450 54450 BCBST 54450 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 64416 NCCI NCCI Refer to Specific Guidelines 54450 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54450 90775 NCCI Standards of medical/surgical practice 54450 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54500 10021 NCCI NCCI Sequential procedures 54500 10022 NCCI NCCI Sequential procedures 54500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 51701 NCCI Standards of medical/surgical practice 54500 51702 NCCI Standards of medical/surgical practice 54500 51703 NCCI Standards of medical/surgical practice 54500 54660 NCCI NCCI HCPCS/CPT separate procedure definition 54500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 64416 NCCI NCCI Refer to Specific Guidelines 54500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54500 90775 NCCI Standards of medical/surgical practice 54500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54505 10021 NCCI NCCI Sequential procedures 54505 10022 NCCI NCCI Sequential procedures 54505 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 306 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54505 51701 NCCI Standards of medical/surgical practice 54505 51702 NCCI Standards of medical/surgical practice 54505 51703 NCCI Standards of medical/surgical practice 54505 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 64416 NCCI NCCI Refer to Specific Guidelines 54505 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54505 90775 NCCI Standards of medical/surgical practice 54505 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54512 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12041 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12042 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12044 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12045 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12046 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 12047 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 13131 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 13132 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 13133 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54512 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 307 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54512 51701 NCCI Standards of medical/surgical practice 54512 51702 NCCI Standards of medical/surgical practice 54512 51703 NCCI 54512 54500 BCBST NCCI Most extensive procedures / The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 54505 BCBST NCCI Most extensive procedures / The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 54620 NCCI 54512 54660 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 54670 BCBST This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54512 54700 BCBST NCCI Most extensive procedures / The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 54800 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 55110 NCCI 54512 55110 BCBST This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54512 55250 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 55450 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54512 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 64416 NCCI NCCI Refer to Specific Guidelines 54512 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54512 69990 BCBST 54512 90775 NCCI Standards of medical/surgical practice 54512 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 49000 NCCI NCCI Standards of medical / surgical practice 54520 49002 NCCI NCCI Standards of medical / surgical practice 54520 49010 NCCI NCCI Standards of medical / surgical practice 54520 51701 NCCI Standards of medical/surgical practice 54520 51702 NCCI Standards of medical/surgical practice 54520 51703 NCCI Standards of medical/surgical practice Standards of medical/surgical practice NCCI HCPCS/CPT separate procedure definition Standards of medical/surgical practice Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 308 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54520 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54520 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54520 54512 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 54520 54522 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 54520 54660 NCCI NCCI HCPCS/CPT separate procedure definition 54520 54690 NCCI NCCI Most extensive procedures 54520 55040 NCCI NCCI Standards of medical / surgical practice 54520 55041 NCCI NCCI Standards of medical / surgical practice 54520 55110 NCCI NCCI Standards of medical / surgical practice 54520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 64416 NCCI NCCI Refer to Specific Guidelines 54520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54520 90775 NCCI Standards of medical/surgical practice 54520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54522 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 309 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54522 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12041 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12042 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12044 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12045 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12046 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 12047 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13131 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13132 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 13133 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 54522 37202 NCCI 54522 49000 BCBST 54522 51701 NCCI Standards of medical/surgical practice 54522 51702 NCCI Standards of medical/surgical practice 54522 51703 NCCI 54522 54500 BCBST NCCI HCPCS/CPT separate procedure definition / This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54522 54505 BCBST NCCI HCPCS/CPT separate procedure definition / This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54522 54512 BCBST NCCI Most extensive procedures / This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54522 54620 NCCI 54522 54660 BCBST NCCI HCPCS/CPT separate procedure definition / The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 54670 BCBST This code is a component of the listed code when performed during the same session. 52351 and 52342 rebundle to 52345. 54522 54690 BCBST The edited code is a component of the listed code when performed during the same session. NCCI Misuse of Column 2 code with Column 1 code The edited code is a component of the listed code when performed as part of the listed procedure. Standards of medical/surgical practice NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 310 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54522 54700 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 54800 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 55110 NCCI 54522 55110 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 55250 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 55450 BCBST The edited procedure involves only incidental additional work when performed with the listed procedure. 54522 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 64416 NCCI NCCI Refer to Specific Guidelines 54522 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54522 69990 BCBST 54522 90775 NCCI Standards of medical/surgical practice 54522 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54530 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 51701 NCCI Standards of medical/surgical practice 54530 51702 NCCI Standards of medical/surgical practice 54530 51703 NCCI Standards of medical/surgical practice 54530 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54530 54512 BCBST 54530 54520 NCCI 54530 54522 BCBST 54530 54620 NCCI NCCI HCPCS/CPT separate procedure definition 54530 54660 NCCI NCCI HCPCS/CPT separate procedure definition 54530 54690 NCCI NCCI Most extensive procedures 54530 55110 NCCI Standards of medical/surgical practice 54530 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 64416 NCCI NCCI Refer to Specific Guidelines Standards of medical/surgical practice Operating microscope typically not required in performing the listed procedure. Similar listed codes with edit disallowed according to NCCI Misuse of Column 2 code with Column 1 code. NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. NCCI Most extensive procedures NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 311 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54530 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54530 NCCI Misuse of Column 2 code with Column 1 code 69990 NCCI 54530 90775 NCCI Standards of medical/surgical practice 54530 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54535 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 44005 NCCI NCCI HCPCS/CPT separate procedure definition 54535 44180 NCCI HCPCS/CPT separate procedure definition 54535 44820 NCCI NCCI HCPCS/CPT separate procedure definition 54535 44850 NCCI NCCI HCPCS/CPT separate procedure definition 54535 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 54535 49000 NCCI NCCI HCPCS/CPT separate procedure definition 54535 49002 NCCI NCCI Standards of medical / surgical practice 54535 49010 NCCI NCCI HCPCS/CPT separate procedure definition 54535 49255 NCCI NCCI HCPCS/CPT separate procedure definition 54535 51701 NCCI Standards of medical/surgical practice 54535 51702 NCCI Standards of medical/surgical practice 54535 51703 NCCI Standards of medical/surgical practice 54535 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54535 54505 NCCI 54535 54512 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 54535 54522 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 54535 54620 NCCI NCCI HCPCS/CPT separate procedure definition 54535 54660 NCCI NCCI HCPCS/CPT separate procedure definition 54535 54690 NCCI NCCI Most extensive procedures 54535 55110 NCCI Standards of medical/surgical practice 54535 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 64416 NCCI NCCI Refer to Specific Guidelines 54535 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54535 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 312 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54535 90775 NCCI Standards of medical/surgical practice 54535 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54550 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 51701 NCCI Standards of medical/surgical practice 54550 51702 NCCI Standards of medical/surgical practice 54550 51703 NCCI Standards of medical/surgical practice 54550 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54550 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54550 54660 NCCI NCCI HCPCS/CPT separate procedure definition 54550 55110 NCCI Standards of medical/surgical practice 54550 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 64416 NCCI NCCI Refer to Specific Guidelines 54550 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54550 90775 NCCI Standards of medical/surgical practice 54550 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54560 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 44005 NCCI NCCI HCPCS/CPT separate procedure definition 54560 44180 NCCI HCPCS/CPT separate procedure definition 54560 44820 NCCI NCCI HCPCS/CPT separate procedure definition 54560 44850 NCCI NCCI HCPCS/CPT separate procedure definition 54560 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 54560 49000 NCCI NCCI HCPCS/CPT separate procedure definition 54560 49002 NCCI NCCI Standards of medical / surgical practice 54560 49010 NCCI NCCI HCPCS/CPT separate procedure definition 54560 49255 NCCI NCCI HCPCS/CPT separate procedure definition 54560 51701 NCCI Standards of medical/surgical practice 54560 51702 NCCI Standards of medical/surgical practice 54560 51703 NCCI Standards of medical/surgical practice 54560 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54560 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54560 54620 NCCI NCCI HCPCS/CPT separate procedure definition 54560 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 313 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54560 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 64416 NCCI NCCI Refer to Specific Guidelines 54560 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54560 90775 NCCI Standards of medical/surgical practice 54560 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 51701 NCCI Standards of medical/surgical practice 54600 51702 NCCI Standards of medical/surgical practice 54600 51703 NCCI Standards of medical/surgical practice 54600 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54600 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54600 54620 NCCI NCCI HCPCS/CPT separate procedure definition 54600 55110 NCCI Standards of medical/surgical practice 54600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 64416 NCCI NCCI Refer to Specific Guidelines 54600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54600 90775 NCCI Standards of medical/surgical practice 54600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54620 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 51701 NCCI Standards of medical/surgical practice 54620 51702 NCCI Standards of medical/surgical practice 54620 51703 NCCI Standards of medical/surgical practice 54620 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54620 55110 NCCI Standards of medical/surgical practice 54620 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 314 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54620 64416 NCCI NCCI Refer to Specific Guidelines 54620 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54620 90775 NCCI Standards of medical/surgical practice 54620 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54640 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 51701 NCCI Standards of medical/surgical practice 54640 51702 NCCI Standards of medical/surgical practice 54640 51703 NCCI Standards of medical/surgical practice 54640 54500 NCCI NCCI HCPCS/CPT separate procedure definition 54640 54505 NCCI NCCI HCPCS/CPT separate procedure definition 54640 54512 NCCI NCCI Refer to Specific Guidelines 54640 54512 NCCI NCCI Standards of medical / surgical practice 54640 54512 NCCI NCCI Standards of medical / surgical practice 54640 54550 NCCI NCCI Standards of medical / surgical practice 54640 54692 NCCI NCCI Most extensive procedures 54640 55110 NCCI Standards of medical/surgical practice 54640 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 64416 NCCI NCCI Refer to Specific Guidelines 54640 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 54640 90775 NCCI Standards of medical/surgical practice 54640 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 54650 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 54650 44005 NCCI NCCI HCPCS/CPT separate procedure definition 54650 44180 NCCI HCPCS/CPT separate procedure definition 54650 44820 NCCI NCCI HCPCS/CPT separate procedure definition 54650 44850 NCCI NCCI HCPCS/CPT separate procedure definition 54650 44950 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 54650 49000 NCCI NCCI HCPCS/CPT separate procedure definition CPT® is a registered trademark of the American Medical Association Current Dental Terminology © 2004 American Dental Association Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: 11/11/2008 Source: PNC-CARR BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 315 of 770 Effective Date of Service: 1/1/2009 BlueCross BlueShield of Tennessee Commercial and Medicaid Code Bundling Rules Comprehensive Code Component Code Source Rationale 54650 49002 NCCI NCCI Standards of medical / surgical practice 54650 49010 NCCI NC

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