Resolved Excludes

[MelindaL_64817]

I have some confusion over the “excludes” meaning for CPT codes. Does it mean the “excluded codes” cannot be coded at the same time or is it to inform you that these can be coded at the same time. Thanks

 

[Jennifer]

Do you have an example? What version of CPT are you using? Expert?

 

[MelindaL_64817]

Yes, from the optum 360 expert book. 31287 says Excludes When performed on the same side: 31255 other total ethmoidectomy procedures. my provider is billing both of these codes with a 50 modifier. I'm thinking they can't be billed together since both are being done bilateral and just wanted some clarification.

 

[Darcy]

AMA Guidelines:

(Do not report 31287 in conjunction with 31235, 31237, 31255, 31257, 31259, 31288, 31291, 31294, 31297, 31298, when performed on the ipsilateral side)

This is specifically telling us the two codes can NOT be coded together when done on same side; so if provider is doing bilaterally, it still means the same.