Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30000 10140 NCCI NCCI Mutually exclusive procedures 30000 30200 NCCI NCCI Standards of medical / surgical practice 30000 30801 NCCI NCCI Standards of medical / surgical practice 30000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 64416 NCCI Misuse of Column 2 code with Column 1 code 30000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30000 90780 NCCI NCCI Standards of medical / surgical practice 30000 92502 NCCI NCCI Standards of medical / surgical practice 30000 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30000 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30020 30000 NCCI NCCI Most extensive procedures 30020 30200 NCCI NCCI Standards of medical / surgical practice 30020 30801 NCCI NCCI Standards of medical / surgical practice 30020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 64416 NCCI Misuse of Column 2 code with Column 1 code 30020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30020 90780 NCCI NCCI Standards of medical / surgical practice 30020 92502 NCCI NCCI Standards of medical / surgical practice 30020 99261 BCBST 30020 99262 BCBST 30020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30100 10021 NCCI NCCI Sequential procedures 30100 10022 NCCI NCCI Sequential procedures CPT TM HCPCS/CPT coding manual instruction/guideline HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 1 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30100 30200 NCCI NCCI Standards of medical / surgical practice 30100 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 64416 NCCI Misuse of Column 2 code with Column 1 code 30100 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30100 90780 NCCI NCCI Standards of medical / surgical practice 30100 92502 NCCI NCCI Standards of medical / surgical practice 30100 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30110 30100 NCCI NCCI Most extensive procedures 30110 30200 NCCI NCCI Standards of medical / surgical practice 30110 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 64416 NCCI Misuse of Column 2 code with Column 1 code 30110 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30110 90780 NCCI NCCI Standards of medical / surgical practice 30110 92502 NCCI NCCI Standards of medical / surgical practice 30110 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30115 30100 NCCI NCCI Most extensive procedures 30115 30110 NCCI NCCI Most extensive procedures 30115 30200 NCCI NCCI Standards of medical / surgical practice 30115 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 64416 NCCI Misuse of Column 2 code with Column 1 code 30115 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 2 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30115 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30115 90780 NCCI NCCI Standards of medical / surgical practice 30115 92502 NCCI NCCI Standards of medical / surgical practice 30115 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30117 30000 NCCI NCCI Most extensive procedures 30117 30020 NCCI NCCI Most extensive procedures 30117 30200 NCCI NCCI Standards of medical / surgical practice 30117 30320 NCCI NCCI Mutually exclusive procedures 30117 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 64416 NCCI Misuse of Column 2 code with Column 1 code 30117 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30117 90780 NCCI NCCI Standards of medical / surgical practice 30117 92502 NCCI NCCI Standards of medical / surgical practice 30117 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30118 30200 NCCI NCCI Standards of medical / surgical practice 30118 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 64416 NCCI Misuse of Column 2 code with Column 1 code 30118 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30118 90780 NCCI NCCI Standards of medical / surgical practice 30118 92502 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 3 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30118 S0020 CPT 30120 30120 BCBST 30120 30200 NCCI NCCI Standards of medical / surgical practice 30120 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 64416 NCCI Misuse of Column 2 code with Column 1 code 30120 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30120 90780 NCCI NCCI Standards of medical / surgical practice 30120 92502 NCCI NCCI Standards of medical / surgical practice 30120 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30124 30200 NCCI NCCI Standards of medical / surgical practice 30124 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 64416 NCCI Misuse of Column 2 code with Column 1 code 30124 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30124 90780 NCCI NCCI Standards of medical / surgical practice 30124 92502 NCCI NCCI Standards of medical / surgical practice 30124 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30125 30124 NCCI NCCI Most extensive procedures 30125 30200 NCCI NCCI Standards of medical / surgical practice 30125 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 64416 NCCI Misuse of Column 2 code with Column 1 code 30125 CPT TM CMS 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 4 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30125 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30125 90780 NCCI NCCI Standards of medical / surgical practice 30125 92502 NCCI NCCI Standards of medical / surgical practice 30125 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30130 30110 NCCI NCCI Most extensive procedures 30130 30115 NCCI NCCI Most extensive procedures 30130 30200 NCCI NCCI Standards of medical / surgical practice 30130 30465 BCBST 30130 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 64416 NCCI Misuse of Column 2 code with Column 1 code 30130 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30130 90780 NCCI NCCI Standards of medical / surgical practice 30130 92502 NCCI NCCI Standards of medical / surgical practice 30130 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30140 30110 NCCI NCCI Most extensive procedures 30140 30115 NCCI NCCI Most extensive procedures 30140 30130 NCCI NCCI Most extensive procedures 30140 30200 NCCI NCCI Standards of medical / surgical practice 30140 30930 BCBST 30140 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM This edit is considered a part of the more extensive listed procedure. 30140 involves removing part or all of the turbinate bone, in which portions of the turbinate bone are chiseled or broken off with forceps. 30930 is a subset of 30140 to address billing for this inherent fracturing of the turbinate bone. It may be appropriate to reimburse 30930, however, if review indicates that 30930 was performed on a separate turbinate and was clinically indicated. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 5 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30140 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30140 90780 NCCI NCCI Standards of medical / surgical practice 30140 92502 NCCI NCCI Standards of medical / surgical practice 30140 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30150 30000 NCCI NCCI Standards of medical / surgical practice 30150 30020 NCCI NCCI Standards of medical / surgical practice 30150 30100 NCCI NCCI Standards of medical / surgical practice 30150 30110 NCCI NCCI Standards of medical / surgical practice 30150 30115 NCCI NCCI Standards of medical / surgical practice 30150 30117 NCCI NCCI Standards of medical / surgical practice 30150 30118 NCCI NCCI Standards of medical / surgical practice 30150 30120 NCCI NCCI Standards of medical / surgical practice 30150 30124 NCCI NCCI Standards of medical / surgical practice 30150 30125 NCCI NCCI Standards of medical / surgical practice 30150 30130 NCCI NCCI Standards of medical / surgical practice 30150 30140 NCCI NCCI Standards of medical / surgical practice 30150 30150 BCBST 30150 30200 NCCI 30150 30465 BCBST 30150 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 64416 NCCI Misuse of Column 2 code with Column 1 code 30150 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30150 90780 NCCI NCCI Standards of medical / surgical practice 30150 92502 NCCI NCCI Standards of medical / surgical practice 30150 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30160 30000 NCCI NCCI Standards of medical / surgical practice 30160 30020 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. NCCI Standards of medical / surgical practice This edit is considered a part of the more extensive listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 6 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30160 30100 NCCI NCCI Standards of medical / surgical practice 30160 30110 NCCI NCCI Standards of medical / surgical practice 30160 30115 NCCI NCCI Standards of medical / surgical practice 30160 30117 NCCI NCCI Standards of medical / surgical practice 30160 30118 NCCI NCCI Standards of medical / surgical practice 30160 30120 NCCI NCCI Standards of medical / surgical practice 30160 30124 NCCI NCCI Standards of medical / surgical practice 30160 30125 NCCI NCCI Standards of medical / surgical practice 30160 30130 NCCI NCCI Standards of medical / surgical practice 30160 30140 NCCI NCCI Standards of medical / surgical practice 30160 30150 NCCI NCCI HCPCS/CPT procedure code definition 30160 30160 BCBST 30160 30200 NCCI 30160 30465 BCBST 30160 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 64416 NCCI Misuse of Column 2 code with Column 1 code 30160 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30160 90780 NCCI NCCI Standards of medical / surgical practice 30160 92502 NCCI NCCI Standards of medical / surgical practice 30160 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 64416 NCCI Misuse of Column 2 code with Column 1 code 30200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30200 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. NCCI Standards of medical / surgical practice This edit is considered a part of the more extensive listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 7 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30200 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30200 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30200 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30200 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30200 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30210 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 64416 NCCI Misuse of Column 2 code with Column 1 code 30210 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30210 90780 NCCI NCCI Standards of medical / surgical practice 30210 92502 NCCI NCCI Standards of medical / surgical practice 30210 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30210 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30210 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30210 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30210 99262 BCBST 30210 S0020 CPT 30220 30220 BCBST 30220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 64416 NCCI Misuse of Column 2 code with Column 1 code 30220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30220 90780 NCCI NCCI Standards of medical / surgical practice 30220 92502 NCCI NCCI Standards of medical / surgical practice CPT TM HCPCS/CPT coding manual instruction/guideline CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 8 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30300 30000 NCCI NCCI Standards of medical / surgical practice 30300 30020 NCCI NCCI Standards of medical / surgical practice 30300 30117 NCCI NCCI Mutually exclusive procedures 30300 30118 NCCI NCCI Mutually exclusive procedures 30300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 64416 NCCI Misuse of Column 2 code with Column 1 code 30300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30300 90780 NCCI NCCI Standards of medical / surgical practice 30300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30310 30000 NCCI NCCI Standards of medical / surgical practice 30310 30020 NCCI NCCI Standards of medical / surgical practice 30310 30117 NCCI NCCI Mutually exclusive procedures 30310 30118 NCCI NCCI Mutually exclusive procedures 30310 30300 NCCI NCCI Most extensive procedures 30310 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 64416 NCCI Misuse of Column 2 code with Column 1 code 30310 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30310 90780 NCCI NCCI Standards of medical / surgical practice 30310 92502 NCCI NCCI Standards of medical / surgical practice 30310 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30320 30000 NCCI NCCI Standards of medical / surgical practice 30320 30020 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 9 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 30320 30300 30320 30320 Source Rationale NCCI NCCI Most extensive procedures 30310 NCCI NCCI Most extensive procedures 30465 BCBST 30320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 64416 NCCI Misuse of Column 2 code with Column 1 code 30320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30320 90780 NCCI NCCI Standards of medical / surgical practice 30320 92502 NCCI NCCI Standards of medical / surgical practice 30320 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30400 30130 NCCI NCCI Most extensive procedures 30400 30400 BCBST 30400 30435 NCCI NCCI Mutually exclusive procedures 30400 30450 NCCI NCCI Mutually exclusive procedures 30400 30460 NCCI NCCI Mutually exclusive procedures 30400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 64416 NCCI Misuse of Column 2 code with Column 1 code 30400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30400 90780 NCCI NCCI Standards of medical / surgical practice 30400 92502 NCCI NCCI Standards of medical / surgical practice 30410 30130 NCCI NCCI Most extensive procedures 30410 30400 NCCI NCCI HCPCS/CPT procedure code definition 30410 30410 BCBST 30410 30450 NCCI 30410 30465 BCBST CPT TM This edit is considered a part of the more extensive listed procedure. Procedure redundant to itself. Procedure redundant to itself. NCCI Mutually exclusive procedures NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 10 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30410 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 64416 NCCI Misuse of Column 2 code with Column 1 code 30410 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30410 90780 NCCI NCCI Standards of medical / surgical practice 30410 92502 NCCI NCCI Standards of medical / surgical practice 30420 30130 NCCI NCCI Most extensive procedures 30420 30420 BCBST 30420 30450 NCCI NCCI Mutually exclusive procedures 30420 30462 NCCI NCCI Mutually exclusive procedures 30420 30462 NCCI NCCI Mutually exclusive procedures 30420 30465 BCBST 30420 30520 NCCI NCCI HCPCS/CPT procedure code definition 30420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 64416 NCCI Misuse of Column 2 code with Column 1 code 30420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30420 90780 NCCI NCCI Standards of medical / surgical practice 30420 92502 NCCI NCCI Standards of medical / surgical practice 30420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30430 30400 NCCI NCCI Mutually exclusive procedures 30430 30410 NCCI NCCI Mutually exclusive procedures 30430 30420 NCCI NCCI Mutually exclusive procedures 30430 30430 BCBST 30430 37202 NCCI CPT TM Code redundant to self/should not be reported more than once due to standard description NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. Procedure redundant to itself. NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 11 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30430 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 64416 NCCI Misuse of Column 2 code with Column 1 code 30430 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30430 90780 NCCI NCCI Standards of medical / surgical practice 30430 92502 NCCI NCCI Standards of medical / surgical practice 30435 30410 NCCI NCCI Mutually exclusive procedures 30435 30420 NCCI NCCI Mutually exclusive procedures 30435 30430 NCCI NCCI Most extensive procedures 30435 30435 BCBST Procedure redundant to itself. 30435 30465 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 30435 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 64416 NCCI Misuse of Column 2 code with Column 1 code 30435 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30435 90780 NCCI NCCI Standards of medical / surgical practice 30435 92502 NCCI NCCI Standards of medical / surgical practice 30435 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30450 30430 NCCI NCCI Most extensive procedures 30450 30435 NCCI NCCI Most extensive procedures 30450 30450 BCBST Procedure redundant to itself. 30450 30465 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 30450 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 12 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30450 64416 NCCI Misuse of Column 2 code with Column 1 code 30450 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30450 90780 NCCI NCCI Standards of medical / surgical practice 30450 92502 NCCI NCCI Standards of medical / surgical practice 30450 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30460 30460 BCBST Procedure redundant to itself. 30460 30465 BCBST This edit is considered a part of the more extensive listed procedure. 30460 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 64416 NCCI Misuse of Column 2 code with Column 1 code 30460 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30460 90780 NCCI NCCI Standards of medical / surgical practice 30460 92502 NCCI NCCI Standards of medical / surgical practice 30460 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30462 30462 BCBST Procedure redundant to itself. 30462 30465 BCBST NCCI Most extensive procedures / This edit is considered a part of the more extensive listed procedure. 30462 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 64416 NCCI Misuse of Column 2 code with Column 1 code 30462 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30462 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 13 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30462 92502 NCCI NCCI Standards of medical / surgical practice 30462 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30465 12011 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12013 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12014 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12015 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12016 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12017 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12018 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12051 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12052 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12053 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12054 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12055 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12056 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 12057 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 13150 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 13151 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 13152 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 13153 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 30465 21325 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 21330 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 30400 BCBST NCCI Most extensive procedures / Redundant procedure if used to report the same service as the listed procedure. 30465 30430 BCBST Redundant procedure if used to report the same service as the listed procedure. 30465 30520 NCCI 30465 30560 BCBST CPT TM NCCI Most extensive procedures The edited procedure involves only incidental additional work when performed with the listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 14 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30465 30901 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 30903 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 30905 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 31231 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 30465 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 64416 NCCI Misuse of Column 2 code with Column 1 code 30465 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30465 69990 BCBST 30465 90780 NCCI 30465 92502 BCBST NCCI Standards of medical / surgical practice / The edited code is a component of the listed code when performed as part of the listed procedure. 30465 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30520 21315 NCCI NCCI Most extensive procedures 30520 21325 NCCI NCCI Most extensive procedures 30520 21330 NCCI NCCI Most extensive procedures 30520 21336 NCCI NCCI Most extensive procedures 30520 21337 NCCI NCCI Most extensive procedures 30520 30100 NCCI NCCI Standards of medical / surgical practice 30520 30110 NCCI NCCI Standards of medical / surgical practice 30520 30220 NCCI NCCI Standards of medical / surgical practice 30520 30520 BCBST Procedure redundant to itself. 30520 30801 BCBST 30801 and 30802 are listed as subsets of 30520 to account for any incidental cauterization of the turbinates that may occur in the course of performing the septoplasty, such as cauterizing a minor bleeder that occurred in the course of performing the septoplasty. It may be appropriate to reimburse 30801 or 30802 if review of the medical records indicated that significant additional work was involved in performing the cauterization in a patient that had significantly inflamed and excessive mucosa. CPT TM 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 Standards of medical / surgical practice is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 15 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30520 30802 BCBST 30801 and 30802 are listed as subsets of 30520 to account for any incidental cauterization of the turbinates that may occur in the course of performing the septoplasty, such as cauterizing a minor bleeder that occurred in the course of performing the septoplasty. It may be appropriate to reimburse 30801 or 30802 if review of the medical records indicated that significant additional work was involved in performing the cauterization in a patient that had significantly inflamed and excessive mucosa. 30520 31231 BCBST 31231 is a subset of 30520 to address visualization of the nasal anatomy at the time of surgery. It may be appropriate to reimburse if it is unrelated to the performance of the septoplasty itself. 30520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 64416 NCCI Misuse of Column 2 code with Column 1 code 30520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30520 90780 NCCI NCCI Standards of medical / surgical practice 30520 92502 NCCI NCCI Standards of medical / surgical practice 30520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30540 30540 BCBST 30540 30560 NCCI NCCI Standards of medical / surgical practice 30540 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 64416 NCCI Misuse of Column 2 code with Column 1 code 30540 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30540 90780 NCCI NCCI Standards of medical / surgical practice 30540 92502 NCCI NCCI Standards of medical / surgical practice 30540 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30545 30545 BCBST 30545 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 16 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30545 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 64416 NCCI Misuse of Column 2 code with Column 1 code 30545 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30545 90780 NCCI NCCI Standards of medical / surgical practice 30545 92502 NCCI NCCI Standards of medical / surgical practice 30560 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 64416 NCCI Misuse of Column 2 code with Column 1 code 30560 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30560 90780 NCCI NCCI Standards of medical / surgical practice 30560 92502 NCCI NCCI Standards of medical / surgical practice 30560 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30560 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30560 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30560 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30560 99262 BCBST 30560 S0020 CPT 30580 30580 BCBST 30580 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 64416 NCCI Misuse of Column 2 code with Column 1 code 30580 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM HCPCS/CPT coding manual instruction/guideline CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 17 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30580 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30580 90780 NCCI NCCI Standards of medical / surgical practice 30580 92502 NCCI NCCI Standards of medical / surgical practice 30580 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30600 30580 NCCI NCCI Mutually exclusive procedures 30600 30600 BCBST 30600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 64416 NCCI Misuse of Column 2 code with Column 1 code 30600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30600 90780 NCCI NCCI Standards of medical / surgical practice 30600 92502 NCCI NCCI Standards of medical / surgical practice 30600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30620 21325 NCCI NCCI Standards of medical / surgical practice 30620 21330 NCCI NCCI Standards of medical / surgical practice 30620 30520 NCCI NCCI Mutually exclusive procedures 30620 30620 BCBST 30620 30630 NCCI NCCI Mutually exclusive procedures 30620 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 64416 NCCI Misuse of Column 2 code with Column 1 code 30620 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30620 90780 NCCI NCCI Standards of medical / surgical practice 30620 92502 NCCI NCCI Standards of medical / surgical practice 30620 S0020 CPT CMS 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 TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 18 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30630 30220 NCCI 30630 30630 BCBST 30630 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 64416 NCCI Misuse of Column 2 code with Column 1 code 30630 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30630 90780 NCCI NCCI Standards of medical / surgical practice 30630 92502 NCCI NCCI Standards of medical / surgical practice 30630 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30801 30801 BCBST 30801 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 64416 NCCI Misuse of Column 2 code with Column 1 code 30801 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30801 90780 NCCI NCCI Standards of medical / surgical practice 30801 92502 NCCI NCCI Standards of medical / surgical practice 30801 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99214 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99215 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30801 99263 BCBST HCPCS/CPT coding manual instruction/guideline 30801 S0020 CPT CPT TM NCCI Standards of medical / surgical practice Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 19 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30802 30802 BCBST Code redundant to self/should not be reported more than once due to standard description 30802 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 64416 NCCI Misuse of Column 2 code with Column 1 code 30802 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30802 90780 NCCI NCCI Standards of medical / surgical practice 30802 92502 NCCI NCCI Standards of medical / surgical practice 30802 99201 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99202 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99203 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99204 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99205 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99214 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99215 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99241 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99242 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99243 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99244 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99245 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30802 99263 BCBST HCPCS/CPT coding manual instruction/guideline 30802 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30901 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 64416 NCCI Misuse of Column 2 code with Column 1 code 30901 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 20 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30901 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30901 90780 NCCI NCCI Standards of medical / surgical practice 30901 92502 NCCI NCCI Standards of medical / surgical practice 30901 92511 NCCI NCCI Standards of medical / surgical practice 30901 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30901 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30901 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30901 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30901 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30901 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30903 30901 NCCI NCCI Most extensive procedures 30903 30906 NCCI NCCI Mutually exclusive procedures 30903 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 64416 NCCI Misuse of Column 2 code with Column 1 code 30903 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30903 90780 NCCI NCCI Standards of medical / surgical practice 30903 92502 NCCI NCCI Standards of medical / surgical practice 30903 92511 NCCI NCCI HCPCS/CPT separate procedure definition 30903 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30903 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30903 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30903 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30903 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30903 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30905 30801 NCCI NCCI HCPCS/CPT separate procedure definition 30905 30802 NCCI NCCI HCPCS/CPT separate procedure definition 30905 30901 NCCI NCCI Most extensive procedures 30905 30903 NCCI NCCI Most extensive procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 21 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30905 30906 NCCI NCCI Mutually exclusive procedures 30905 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 64416 NCCI Misuse of Column 2 code with Column 1 code 30905 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30905 90780 NCCI NCCI Standards of medical / surgical practice 30905 92502 NCCI NCCI Standards of medical / surgical practice 30905 92511 NCCI NCCI HCPCS/CPT separate procedure definition 30905 99211 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99214 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99215 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30905 99263 BCBST HCPCS/CPT coding manual instruction/guideline 30905 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30906 30801 NCCI NCCI HCPCS/CPT separate procedure definition 30906 30802 NCCI NCCI HCPCS/CPT separate procedure definition 30906 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 64416 NCCI Misuse of Column 2 code with Column 1 code 30906 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30906 90780 NCCI NCCI Standards of medical / surgical practice 30906 92502 NCCI NCCI Standards of medical / surgical practice 30906 99211 BCBST CPT TM HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 22 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30906 99212 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99213 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99214 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99215 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99261 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99262 BCBST HCPCS/CPT coding manual instruction/guideline 30906 99263 BCBST 30906 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30915 30801 NCCI NCCI HCPCS/CPT separate procedure definition 30915 30802 NCCI NCCI HCPCS/CPT separate procedure definition 30915 30901 NCCI NCCI Most extensive procedures 30915 30903 NCCI NCCI Most extensive procedures 30915 30905 NCCI NCCI Most extensive procedures 30915 30906 NCCI NCCI Most extensive procedures 30915 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 64416 NCCI Misuse of Column 2 code with Column 1 code 30915 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30915 90780 NCCI NCCI Standards of medical / surgical practice 30915 92502 NCCI NCCI Standards of medical / surgical practice 30915 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30920 30801 NCCI NCCI HCPCS/CPT separate procedure definition 30920 30802 NCCI NCCI HCPCS/CPT separate procedure definition 30920 30901 NCCI NCCI Most extensive procedures 30920 30903 NCCI NCCI Most extensive procedures 30920 30905 NCCI NCCI Most extensive procedures 30920 30906 NCCI NCCI Most extensive procedures 30920 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 23 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 30920 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30920 90780 NCCI NCCI Standards of medical / surgical practice 30920 92502 NCCI NCCI Standards of medical / surgical practice 30920 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30930 30801 NCCI NCCI HCPCS/CPT separate procedure definition 30930 30802 NCCI NCCI HCPCS/CPT separate procedure definition 30930 30901 NCCI NCCI Standards of medical / surgical practice 30930 30903 NCCI NCCI Standards of medical / surgical practice 30930 30905 NCCI NCCI Standards of medical / surgical practice 30930 30906 NCCI NCCI Standards of medical / surgical practice 30930 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 64416 NCCI Misuse of Column 2 code with Column 1 code 30930 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 30930 90780 NCCI NCCI Standards of medical / surgical practice 30930 92502 NCCI NCCI Standards of medical / surgical practice 30930 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 30999 30999 BCBST 30999 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 64416 NCCI Misuse of Column 2 code with Column 1 code 31000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 24 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31000 90780 NCCI NCCI Standards of medical / surgical practice 31000 92502 NCCI NCCI Standards of medical / surgical practice 31000 99211 BCBST HCPCS/CPT coding manual instruction/guideline 31000 99212 BCBST HCPCS/CPT coding manual instruction/guideline 31000 99213 BCBST HCPCS/CPT coding manual instruction/guideline 31000 99261 BCBST HCPCS/CPT coding manual instruction/guideline 31000 99262 BCBST 31000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31002 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 64416 NCCI Misuse of Column 2 code with Column 1 code 31002 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31002 90780 NCCI NCCI Standards of medical / surgical practice 31002 92502 NCCI NCCI Standards of medical / surgical practice 31002 99211 BCBST HCPCS/CPT coding manual instruction/guideline 31002 99212 BCBST HCPCS/CPT coding manual instruction/guideline 31002 99213 BCBST HCPCS/CPT coding manual instruction/guideline 31002 99261 BCBST HCPCS/CPT coding manual instruction/guideline 31002 99262 BCBST 31002 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31020 31000 NCCI NCCI Standards of medical / surgical practice 31020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 64416 NCCI Misuse of Column 2 code with Column 1 code 31020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM HCPCS/CPT coding manual instruction/guideline HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 25 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31020 90780 NCCI NCCI Standards of medical / surgical practice 31020 92502 NCCI NCCI Standards of medical / surgical practice 31020 D7560 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. 31020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31030 31000 NCCI NCCI Standards of medical / surgical practice 31030 31020 NCCI NCCI Most extensive procedures 31030 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 64416 NCCI Misuse of Column 2 code with Column 1 code 31030 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31030 90780 NCCI NCCI Standards of medical / surgical practice 31030 92502 NCCI NCCI Standards of medical / surgical practice 31030 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31032 31000 NCCI NCCI Standards of medical / surgical practice 31032 31020 NCCI NCCI Most extensive procedures 31032 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 64416 NCCI Misuse of Column 2 code with Column 1 code 31032 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31032 90780 NCCI NCCI Standards of medical / surgical practice 31032 92502 NCCI NCCI Standards of medical / surgical practice 31032 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31040 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 26 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31040 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 64416 NCCI Misuse of Column 2 code with Column 1 code 31040 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31040 90780 NCCI NCCI Standards of medical / surgical practice 31040 92502 NCCI NCCI Standards of medical / surgical practice 31040 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31050 31002 NCCI NCCI Standards of medical / surgical practice 31050 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 64416 NCCI Misuse of Column 2 code with Column 1 code 31050 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31050 90780 NCCI NCCI Standards of medical / surgical practice 31050 92502 NCCI NCCI Standards of medical / surgical practice 31050 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31051 31002 NCCI NCCI Standards of medical / surgical practice 31051 31050 NCCI NCCI HCPCS/CPT procedure code definition 31051 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 64416 NCCI Misuse of Column 2 code with Column 1 code 31051 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31051 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 27 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31051 92502 NCCI NCCI Standards of medical / surgical practice 31051 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31070 31051 NCCI NCCI Mutually exclusive procedures 31070 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 64416 NCCI Misuse of Column 2 code with Column 1 code 31070 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31070 90780 NCCI NCCI Standards of medical / surgical practice 31070 92502 NCCI NCCI Standards of medical / surgical practice 31070 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31075 31205 NCCI NCCI Most extensive procedures 31075 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 64416 NCCI Misuse of Column 2 code with Column 1 code 31075 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31075 90780 NCCI NCCI Standards of medical / surgical practice 31075 92502 NCCI NCCI Standards of medical / surgical practice 31075 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31080 31080 BCBST 31080 31081 NCCI NCCI Mutually exclusive procedures 31080 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 64416 NCCI Misuse of Column 2 code with Column 1 code 31080 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 28 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31080 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31080 90780 NCCI NCCI Standards of medical / surgical practice 31080 92502 NCCI NCCI Standards of medical / surgical practice 31081 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 64416 NCCI Misuse of Column 2 code with Column 1 code 31081 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31081 90780 NCCI NCCI Standards of medical / surgical practice 31081 92502 NCCI NCCI Standards of medical / surgical practice 31084 31085 NCCI NCCI Mutually exclusive procedures 31084 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 64416 NCCI Misuse of Column 2 code with Column 1 code 31084 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31084 90780 NCCI NCCI Standards of medical / surgical practice 31084 92502 NCCI NCCI Standards of medical / surgical practice 31085 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 64416 NCCI Misuse of Column 2 code with Column 1 code 31085 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 29 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31085 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31085 90780 NCCI NCCI Standards of medical / surgical practice 31085 92502 NCCI NCCI Standards of medical / surgical practice 31086 31087 NCCI NCCI Mutually exclusive procedures 31086 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 64416 NCCI Misuse of Column 2 code with Column 1 code 31086 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31086 90780 NCCI NCCI Standards of medical / surgical practice 31086 92502 NCCI NCCI Standards of medical / surgical practice 31086 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31087 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 64416 NCCI Misuse of Column 2 code with Column 1 code 31087 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31087 90780 NCCI NCCI Standards of medical / surgical practice 31087 92502 NCCI NCCI Standards of medical / surgical practice 31087 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31090 31080 NCCI NCCI Mutually exclusive procedures 31090 31081 NCCI NCCI Mutually exclusive procedures 31090 31084 NCCI NCCI Mutually exclusive procedures 31090 31085 NCCI NCCI Mutually exclusive procedures 31090 31086 NCCI NCCI Mutually exclusive procedures 31090 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 30 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31090 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 64416 NCCI Misuse of Column 2 code with Column 1 code 31090 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31090 90780 NCCI NCCI Standards of medical / surgical practice 31090 92502 NCCI NCCI Standards of medical / surgical practice 31090 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31200 30100 NCCI NCCI Standards of medical / surgical practice 31200 30110 NCCI NCCI Standards of medical / surgical practice 31200 30115 NCCI NCCI Standards of medical / surgical practice 31200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 64416 NCCI Misuse of Column 2 code with Column 1 code 31200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31200 90780 NCCI NCCI Standards of medical / surgical practice 31200 92502 NCCI NCCI Standards of medical / surgical practice 31200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31201 30100 NCCI NCCI Standards of medical / surgical practice 31201 30110 NCCI NCCI Standards of medical / surgical practice 31201 30115 NCCI NCCI Standards of medical / surgical practice 31201 31200 BCBST 31201 31200 NCCI NCCI HCPCS/CPT procedure code definition 31201 31200 NCCI NCCI HCPCS/CPT procedure code definition 31201 31254 NCCI NCCI Sequential procedures 31201 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Refer to Specific Guidelines is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 31 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31201 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 64416 NCCI Misuse of Column 2 code with Column 1 code 31201 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31201 90780 NCCI NCCI Standards of medical / surgical practice 31201 92502 NCCI NCCI Standards of medical / surgical practice 31201 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31205 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 64416 NCCI Misuse of Column 2 code with Column 1 code 31205 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31205 90780 NCCI NCCI Standards of medical / surgical practice 31205 92502 NCCI NCCI Standards of medical / surgical practice 31205 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31225 31020 NCCI NCCI Most extensive procedures 31225 31030 NCCI NCCI Most extensive procedures 31225 31032 NCCI NCCI Most extensive procedures 31225 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 64416 NCCI Misuse of Column 2 code with Column 1 code 31225 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31225 65112 NCCI NCCI Mutually exclusive procedures 31225 65114 NCCI NCCI Mutually exclusive procedures 31225 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 32 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31225 Source Rationale 90780 NCCI 31225 92502 NCCI NCCI Standards of medical / surgical practice 31225 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31230 31020 NCCI NCCI Most extensive procedures 31230 31030 NCCI NCCI Most extensive procedures 31230 31032 NCCI NCCI Most extensive procedures 31230 31225 NCCI NCCI "With" versus "without" procedures 31230 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 64416 NCCI Misuse of Column 2 code with Column 1 code 31230 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 65110 NCCI NCCI Standards of medical / surgical practice 31230 65112 NCCI NCCI Standards of medical / surgical practice 31230 65114 NCCI NCCI Standards of medical / surgical practice 31230 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31230 90780 NCCI NCCI Standards of medical / surgical practice 31230 92502 NCCI NCCI Standards of medical / surgical practice 31230 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31231 30901 NCCI NCCI Standards of medical / surgical practice 31231 31231 BCBST 31231 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 64416 NCCI Misuse of Column 2 code with Column 1 code 31231 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31231 90780 NCCI NCCI Standards of medical / surgical practice 31231 92502 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 33 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31231 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31231 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31233 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31233 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 64416 NCCI Misuse of Column 2 code with Column 1 code 31233 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31233 90780 NCCI NCCI Standards of medical / surgical practice 31233 92502 NCCI NCCI Standards of medical / surgical practice 31233 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31233 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31235 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31235 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 64416 NCCI Misuse of Column 2 code with Column 1 code 31235 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31235 90780 NCCI NCCI Standards of medical / surgical practice 31235 92502 NCCI NCCI Standards of medical / surgical practice 31235 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31235 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31237 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31237 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31237 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31237 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 34 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31237 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 64416 NCCI Misuse of Column 2 code with Column 1 code 31237 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31237 90780 NCCI NCCI Standards of medical / surgical practice 31237 92502 NCCI NCCI Standards of medical / surgical practice 31237 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31237 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31238 30901 NCCI NCCI Most extensive procedures 31238 30903 NCCI NCCI Most extensive procedures 31238 30905 NCCI NCCI Most extensive procedures 31238 30906 NCCI NCCI Most extensive procedures 31238 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31238 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31238 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31238 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31238 31238 BCBST 31238 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 64416 NCCI Misuse of Column 2 code with Column 1 code 31238 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31238 90780 NCCI NCCI Standards of medical / surgical practice 31238 92502 NCCI NCCI Standards of medical / surgical practice 31238 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31238 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31239 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31239 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 35 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31239 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31239 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31239 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 64416 NCCI Misuse of Column 2 code with Column 1 code 31239 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31239 90780 NCCI NCCI Standards of medical / surgical practice 31239 92502 NCCI NCCI Standards of medical / surgical practice 31239 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31239 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31240 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31240 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31240 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31240 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 64416 NCCI Misuse of Column 2 code with Column 1 code 31240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31240 90780 NCCI NCCI Standards of medical / surgical practice 31240 92502 NCCI NCCI Standards of medical / surgical practice 31240 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31254 30901 NCCI NCCI Sequential procedures 31254 30903 NCCI NCCI Sequential procedures 31254 30905 NCCI NCCI Sequential procedures 31254 30906 NCCI NCCI Sequential procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 36 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31254 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31254 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31254 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31254 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31254 31238 NCCI NCCI Most extensive procedures 31254 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 64416 NCCI Misuse of Column 2 code with Column 1 code 31254 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31254 90780 NCCI NCCI Standards of medical / surgical practice 31254 92502 NCCI NCCI Standards of medical / surgical practice 31254 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31254 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31255 30901 NCCI NCCI Sequential procedures 31255 30903 NCCI NCCI Sequential procedures 31255 30905 NCCI NCCI Sequential procedures 31255 30906 NCCI NCCI Sequential procedures 31255 31200 NCCI NCCI HCPCS/CPT procedure code definition 31255 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31255 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31255 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31255 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31255 31238 NCCI NCCI Most extensive procedures 31255 31254 BCBST NCCI Most extensive procedures 31255 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 64416 NCCI Misuse of Column 2 code with Column 1 code 31255 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 37 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31255 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31255 90780 NCCI NCCI Standards of medical / surgical practice 31255 92502 NCCI NCCI Standards of medical / surgical practice 31255 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31255 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31256 30901 NCCI NCCI Standards of medical / surgical practice 31256 30903 NCCI NCCI Standards of medical / surgical practice 31256 30905 NCCI NCCI Standards of medical / surgical practice 31256 31000 NCCI NCCI Most extensive procedures 31256 31020 NCCI NCCI Sequential procedures 31256 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31256 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31256 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31256 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31256 31238 NCCI NCCI Most extensive procedures 31256 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 64416 NCCI Misuse of Column 2 code with Column 1 code 31256 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31256 90780 NCCI NCCI Standards of medical / surgical practice 31256 92502 NCCI NCCI Standards of medical / surgical practice 31256 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31256 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31267 30901 NCCI NCCI Standards of medical / surgical practice 31267 30903 NCCI NCCI Standards of medical / surgical practice 31267 30905 NCCI NCCI Standards of medical / surgical practice 31267 30906 NCCI NCCI Standards of medical / surgical practice 31267 31000 NCCI NCCI Most extensive procedures 31267 31020 NCCI NCCI Sequential procedures 31267 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31267 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 38 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31267 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31267 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31267 31238 NCCI NCCI Most extensive procedures 31267 31256 BCBST NCCI Most extensive procedures 31267 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 64416 NCCI Misuse of Column 2 code with Column 1 code 31267 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31267 90780 NCCI NCCI Standards of medical / surgical practice 31267 92502 NCCI NCCI Standards of medical / surgical practice 31267 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31267 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31276 30901 NCCI NCCI Standards of medical / surgical practice 31276 30903 NCCI NCCI Standards of medical / surgical practice 31276 30905 NCCI NCCI Standards of medical / surgical practice 31276 30906 NCCI NCCI Standards of medical / surgical practice 31276 31070 NCCI NCCI Sequential procedures 31276 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31276 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31276 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31276 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31276 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 64416 NCCI Misuse of Column 2 code with Column 1 code 31276 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31276 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 39 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31276 Source Rationale 92502 NCCI 31276 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31276 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31287 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31287 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31287 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31287 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31287 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 64416 NCCI Misuse of Column 2 code with Column 1 code 31287 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31287 90780 NCCI NCCI Standards of medical / surgical practice 31287 92502 NCCI NCCI Standards of medical / surgical practice 31287 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31287 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31288 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31288 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31288 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31288 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31288 31287 BCBST 31288 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 64416 NCCI Misuse of Column 2 code with Column 1 code 31288 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31288 90780 NCCI NCCI Standards of medical / surgical practice 31288 92502 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI Standards of medical / surgical practice NCCI HCPCS/CPT procedure code definition is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 40 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31288 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31288 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31290 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31290 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31290 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31290 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31290 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 64416 NCCI Misuse of Column 2 code with Column 1 code 31290 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31290 90780 NCCI NCCI Standards of medical / surgical practice 31290 92502 NCCI NCCI Standards of medical / surgical practice 31290 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31290 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31291 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31291 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31291 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31291 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31291 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 64416 NCCI Misuse of Column 2 code with Column 1 code 31291 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31291 90780 NCCI NCCI Standards of medical / surgical practice 31291 92502 NCCI NCCI Standards of medical / surgical practice 31291 92511 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 41 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31291 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31292 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31292 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31292 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31292 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31292 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 64416 NCCI Misuse of Column 2 code with Column 1 code 31292 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31292 90780 NCCI NCCI Standards of medical / surgical practice 31292 92502 NCCI NCCI Standards of medical / surgical practice 31292 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31292 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31293 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31293 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31293 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31293 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31293 31292 BCBST 31293 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 64416 NCCI Misuse of Column 2 code with Column 1 code 31293 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31293 90780 NCCI NCCI Standards of medical / surgical practice 31293 92502 NCCI NCCI Standards of medical / surgical practice 31293 92511 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM NCCI HCPCS/CPT procedure code definition is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 42 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31293 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31294 31231 NCCI NCCI HCPCS/CPT separate procedure definition 31294 31233 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31294 31235 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31294 31237 NCCI NCCI HCPCS/CPT separate procedure definition 31294 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 64416 NCCI Misuse of Column 2 code with Column 1 code 31294 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31294 90780 NCCI NCCI Standards of medical / surgical practice 31294 92502 NCCI NCCI Standards of medical / surgical practice 31294 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31294 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31299 31299 BCBST 31299 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31300 00320 NCCI Anesthesia included in surgical procedures 31300 00326 NCCI Anesthesia included in surgical procedures 31300 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31300 31300 BCBST 31300 31320 NCCI NCCI Sequential procedures 31300 31390 NCCI NCCI Mutually exclusive procedures 31300 31395 NCCI NCCI Mutually exclusive procedures 31300 31505 NCCI NCCI Standards of medical / surgical practice 31300 31510 NCCI NCCI Standards of medical / surgical practice 31300 31511 NCCI NCCI Standards of medical / surgical practice 31300 31512 NCCI NCCI Standards of medical / surgical practice 31300 31513 NCCI NCCI Standards of medical / surgical practice 31300 31515 NCCI NCCI Standards of medical / surgical practice 31300 31520 NCCI NCCI Standards of medical / surgical practice 31300 31525 NCCI NCCI Standards of medical / surgical practice 31300 31526 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 43 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31300 31527 NCCI NCCI Standards of medical / surgical practice 31300 31528 NCCI NCCI Standards of medical / surgical practice 31300 31529 NCCI NCCI Standards of medical / surgical practice 31300 31530 NCCI NCCI Standards of medical / surgical practice 31300 31531 NCCI NCCI Standards of medical / surgical practice 31300 31536 NCCI NCCI Standards of medical / surgical practice 31300 31540 NCCI NCCI Standards of medical / surgical practice 31300 31541 NCCI NCCI Standards of medical / surgical practice 31300 31560 NCCI NCCI Standards of medical / surgical practice 31300 31561 NCCI NCCI Standards of medical / surgical practice 31300 31570 NCCI NCCI Standards of medical / surgical practice 31300 31571 NCCI NCCI Standards of medical / surgical practice 31300 31575 NCCI NCCI Sequential procedures 31300 31576 NCCI NCCI Standards of medical / surgical practice 31300 31577 NCCI NCCI Standards of medical / surgical practice 31300 31578 NCCI NCCI Standards of medical / surgical practice 31300 31579 NCCI NCCI Most extensive procedures 31300 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31300 31612 NCCI NCCI Most extensive procedures 31300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 64416 NCCI Misuse of Column 2 code with Column 1 code 31300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31300 90780 NCCI NCCI Standards of medical / surgical practice 31300 92502 NCCI NCCI Standards of medical / surgical practice 31300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31320 00320 NCCI Anesthesia included in surgical procedures 31320 00326 NCCI Anesthesia included in surgical procedures 31320 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31320 31320 BCBST 31320 31390 NCCI NCCI Mutually exclusive procedures 31320 31395 NCCI NCCI Mutually exclusive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 44 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31320 31505 NCCI NCCI Standards of medical / surgical practice 31320 31510 NCCI NCCI Standards of medical / surgical practice 31320 31511 NCCI NCCI Standards of medical / surgical practice 31320 31512 NCCI NCCI Standards of medical / surgical practice 31320 31513 NCCI NCCI Standards of medical / surgical practice 31320 31515 NCCI NCCI Standards of medical / surgical practice 31320 31520 NCCI NCCI Standards of medical / surgical practice 31320 31525 NCCI NCCI Standards of medical / surgical practice 31320 31526 NCCI NCCI Standards of medical / surgical practice 31320 31527 NCCI NCCI Standards of medical / surgical practice 31320 31528 NCCI NCCI Standards of medical / surgical practice 31320 31529 NCCI NCCI Standards of medical / surgical practice 31320 31530 NCCI NCCI Standards of medical / surgical practice 31320 31531 NCCI NCCI Standards of medical / surgical practice 31320 31536 NCCI NCCI Standards of medical / surgical practice 31320 31540 NCCI NCCI Standards of medical / surgical practice 31320 31541 NCCI NCCI Standards of medical / surgical practice 31320 31560 NCCI NCCI Standards of medical / surgical practice 31320 31561 NCCI NCCI Standards of medical / surgical practice 31320 31570 NCCI NCCI Standards of medical / surgical practice 31320 31571 NCCI NCCI Standards of medical / surgical practice 31320 31575 NCCI NCCI Standards of medical / surgical practice 31320 31576 NCCI NCCI Standards of medical / surgical practice 31320 31577 NCCI NCCI Standards of medical / surgical practice 31320 31578 NCCI NCCI Standards of medical / surgical practice 31320 31579 NCCI NCCI Most extensive procedures 31320 31580 NCCI NCCI Mutually exclusive procedures 31320 31582 NCCI NCCI Mutually exclusive procedures 31320 31584 NCCI NCCI Mutually exclusive procedures 31320 31587 NCCI NCCI Mutually exclusive procedures 31320 31588 NCCI NCCI Mutually exclusive procedures 31320 31590 NCCI NCCI Mutually exclusive procedures 31320 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31320 31605 NCCI NCCI Most extensive procedures 31320 31610 NCCI NCCI Mutually exclusive procedures 31320 31611 NCCI NCCI Mutually exclusive procedures 31320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 45 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 64416 NCCI Misuse of Column 2 code with Column 1 code 31320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31320 90780 NCCI NCCI Standards of medical / surgical practice 31320 92502 NCCI NCCI Standards of medical / surgical practice 31360 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31360 31300 NCCI NCCI Most extensive procedures 31360 31320 NCCI NCCI Most extensive procedures 31360 31360 BCBST 31360 31367 NCCI NCCI Most extensive procedures 31360 31370 NCCI NCCI Most extensive procedures 31360 31375 NCCI NCCI Most extensive procedures 31360 31380 NCCI NCCI Most extensive procedures 31360 31382 NCCI NCCI Most extensive procedures 31360 31390 NCCI NCCI Mutually exclusive procedures 31360 31395 NCCI NCCI Mutually exclusive procedures 31360 31505 NCCI NCCI Standards of medical / surgical practice 31360 31510 NCCI NCCI Standards of medical / surgical practice 31360 31511 NCCI NCCI Standards of medical / surgical practice 31360 31512 NCCI NCCI Standards of medical / surgical practice 31360 31513 NCCI NCCI Standards of medical / surgical practice 31360 31515 NCCI NCCI Standards of medical / surgical practice 31360 31520 NCCI NCCI Standards of medical / surgical practice 31360 31525 NCCI NCCI Standards of medical / surgical practice 31360 31526 NCCI NCCI Standards of medical / surgical practice 31360 31527 NCCI NCCI Standards of medical / surgical practice 31360 31528 NCCI NCCI Standards of medical / surgical practice 31360 31529 NCCI NCCI Standards of medical / surgical practice 31360 31530 NCCI NCCI Standards of medical / surgical practice 31360 31531 NCCI NCCI Standards of medical / surgical practice 31360 31535 NCCI NCCI Standards of medical / surgical practice 31360 31536 NCCI NCCI Standards of medical / surgical practice 31360 31540 NCCI NCCI Standards of medical / surgical practice 31360 31541 NCCI NCCI Standards of medical / surgical practice 31360 31560 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 46 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31360 31561 NCCI NCCI Standards of medical / surgical practice 31360 31570 NCCI NCCI Standards of medical / surgical practice 31360 31571 NCCI NCCI Standards of medical / surgical practice 31360 31575 NCCI NCCI Standards of medical / surgical practice 31360 31576 NCCI NCCI Standards of medical / surgical practice 31360 31577 NCCI NCCI Standards of medical / surgical practice 31360 31578 NCCI NCCI Standards of medical / surgical practice 31360 31579 NCCI NCCI Most extensive procedures 31360 31595 NCCI NCCI Standards of medical / surgical practice 31360 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31360 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 38720 NCCI Misuse of Column 2 code with Column 1 code 31360 38724 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 60220 NCCI NCCI Most extensive procedures 31360 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 64416 NCCI Misuse of Column 2 code with Column 1 code 31360 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31360 90780 NCCI NCCI Standards of medical / surgical practice 31360 92502 NCCI NCCI Standards of medical / surgical practice 31360 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31365 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31365 31300 NCCI NCCI Most extensive procedures 31365 31320 NCCI NCCI Most extensive procedures 31365 31360 NCCI NCCI "With" versus "without" procedures 31365 31365 BCBST 31365 31367 NCCI NCCI Most extensive procedures 31365 31368 NCCI NCCI Most extensive procedures 31365 31370 NCCI NCCI Most extensive procedures 31365 31375 NCCI NCCI Most extensive procedures 31365 31380 NCCI NCCI Most extensive procedures 31365 31382 NCCI NCCI Most extensive procedures 31365 31395 NCCI NCCI Mutually exclusive procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 47 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31365 31505 NCCI NCCI Standards of medical / surgical practice 31365 31510 NCCI NCCI Standards of medical / surgical practice 31365 31511 NCCI NCCI Standards of medical / surgical practice 31365 31512 NCCI NCCI Standards of medical / surgical practice 31365 31513 NCCI NCCI Standards of medical / surgical practice 31365 31515 NCCI NCCI Standards of medical / surgical practice 31365 31520 NCCI NCCI Standards of medical / surgical practice 31365 31525 NCCI NCCI Sequential procedures 31365 31526 NCCI NCCI Sequential procedures 31365 31527 NCCI NCCI Standards of medical / surgical practice 31365 31528 NCCI NCCI Standards of medical / surgical practice 31365 31529 NCCI NCCI Standards of medical / surgical practice 31365 31530 NCCI NCCI Standards of medical / surgical practice 31365 31531 NCCI NCCI Standards of medical / surgical practice 31365 31535 NCCI NCCI Standards of medical / surgical practice 31365 31536 NCCI NCCI Standards of medical / surgical practice 31365 31540 NCCI NCCI Standards of medical / surgical practice 31365 31541 NCCI NCCI Standards of medical / surgical practice 31365 31560 NCCI NCCI Standards of medical / surgical practice 31365 31561 NCCI NCCI Standards of medical / surgical practice 31365 31570 NCCI NCCI Standards of medical / surgical practice 31365 31571 NCCI NCCI Standards of medical / surgical practice 31365 31575 NCCI NCCI Standards of medical / surgical practice 31365 31576 NCCI NCCI Standards of medical / surgical practice 31365 31577 NCCI NCCI Standards of medical / surgical practice 31365 31578 NCCI NCCI Standards of medical / surgical practice 31365 31579 NCCI NCCI Most extensive procedures 31365 31595 NCCI NCCI Standards of medical / surgical practice 31365 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31365 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 38720 NCCI NCCI HCPCS/CPT procedure code definition 31365 38724 NCCI NCCI HCPCS/CPT procedure code definition 31365 60220 NCCI NCCI Most extensive procedures 31365 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 64416 NCCI Misuse of Column 2 code with Column 1 code 31365 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 48 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31365 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31365 90780 NCCI NCCI Standards of medical / surgical practice 31365 92502 NCCI NCCI Standards of medical / surgical practice 31365 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31367 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31367 31300 NCCI NCCI Most extensive procedures 31367 31320 NCCI NCCI Most extensive procedures 31367 31367 BCBST 31367 31370 NCCI NCCI Most extensive procedures 31367 31375 NCCI NCCI Most extensive procedures 31367 31380 NCCI NCCI Most extensive procedures 31367 31382 NCCI NCCI Most extensive procedures 31367 31390 NCCI NCCI Mutually exclusive procedures 31367 31395 NCCI NCCI Mutually exclusive procedures 31367 31505 NCCI NCCI Standards of medical / surgical practice 31367 31510 NCCI NCCI Standards of medical / surgical practice 31367 31511 NCCI NCCI Standards of medical / surgical practice 31367 31512 NCCI NCCI Standards of medical / surgical practice 31367 31513 NCCI NCCI Standards of medical / surgical practice 31367 31515 NCCI NCCI Standards of medical / surgical practice 31367 31520 NCCI NCCI Standards of medical / surgical practice 31367 31525 NCCI NCCI Sequential procedures 31367 31526 NCCI NCCI Sequential procedures 31367 31527 NCCI NCCI Standards of medical / surgical practice 31367 31528 NCCI NCCI Standards of medical / surgical practice 31367 31529 NCCI NCCI Standards of medical / surgical practice 31367 31530 NCCI NCCI Standards of medical / surgical practice 31367 31531 NCCI NCCI Standards of medical / surgical practice 31367 31535 NCCI NCCI Standards of medical / surgical practice 31367 31536 NCCI NCCI Standards of medical / surgical practice 31367 31540 NCCI NCCI Standards of medical / surgical practice 31367 31541 NCCI NCCI Standards of medical / surgical practice 31367 31560 NCCI NCCI Standards of medical / surgical practice 31367 31561 NCCI NCCI Standards of medical / surgical practice 31367 31570 NCCI NCCI Standards of medical / surgical practice 31367 31571 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 49 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31367 31575 NCCI NCCI Standards of medical / surgical practice 31367 31576 NCCI NCCI Standards of medical / surgical practice 31367 31577 NCCI NCCI Standards of medical / surgical practice 31367 31578 NCCI NCCI Standards of medical / surgical practice 31367 31579 NCCI NCCI Most extensive procedures 31367 31595 NCCI NCCI Standards of medical / surgical practice 31367 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31367 31611 NCCI NCCI Standards of medical / surgical practice 31367 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 38720 NCCI Misuse of Column 2 code with Column 1 code 31367 38724 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 64416 NCCI Misuse of Column 2 code with Column 1 code 31367 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31367 90780 NCCI NCCI Standards of medical / surgical practice 31367 92502 NCCI NCCI Standards of medical / surgical practice 31367 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31368 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31368 31300 NCCI NCCI Most extensive procedures 31368 31320 NCCI NCCI Most extensive procedures 31368 31367 NCCI NCCI "With" versus "without" procedures 31368 31368 BCBST 31368 31370 NCCI NCCI Most extensive procedures 31368 31375 NCCI NCCI Most extensive procedures 31368 31380 NCCI NCCI Most extensive procedures 31368 31382 NCCI NCCI Most extensive procedures 31368 31395 NCCI NCCI Mutually exclusive procedures 31368 31505 NCCI NCCI Standards of medical / surgical practice 31368 31510 NCCI NCCI Standards of medical / surgical practice 31368 31511 NCCI NCCI Standards of medical / surgical practice 31368 31512 NCCI NCCI Standards of medical / surgical practice 31368 31513 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 50 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31368 31515 NCCI NCCI Standards of medical / surgical practice 31368 31520 NCCI NCCI Standards of medical / surgical practice 31368 31525 NCCI NCCI Sequential procedures 31368 31526 NCCI NCCI Sequential procedures 31368 31527 NCCI NCCI Standards of medical / surgical practice 31368 31528 NCCI NCCI Standards of medical / surgical practice 31368 31529 NCCI NCCI Standards of medical / surgical practice 31368 31530 NCCI NCCI Standards of medical / surgical practice 31368 31531 NCCI NCCI Standards of medical / surgical practice 31368 31535 NCCI NCCI Standards of medical / surgical practice 31368 31536 NCCI NCCI Standards of medical / surgical practice 31368 31540 NCCI NCCI Standards of medical / surgical practice 31368 31541 NCCI NCCI Standards of medical / surgical practice 31368 31560 NCCI NCCI Standards of medical / surgical practice 31368 31561 NCCI NCCI Standards of medical / surgical practice 31368 31570 NCCI NCCI Standards of medical / surgical practice 31368 31571 NCCI NCCI Standards of medical / surgical practice 31368 31575 NCCI NCCI Standards of medical / surgical practice 31368 31576 NCCI NCCI Standards of medical / surgical practice 31368 31577 NCCI NCCI Standards of medical / surgical practice 31368 31578 NCCI NCCI Standards of medical / surgical practice 31368 31579 NCCI NCCI Most extensive procedures 31368 31595 NCCI NCCI Standards of medical / surgical practice 31368 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31368 31611 NCCI NCCI Standards of medical / surgical practice 31368 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 38720 NCCI NCCI HCPCS/CPT procedure code definition 31368 38724 NCCI NCCI HCPCS/CPT procedure code definition 31368 60220 NCCI NCCI Most extensive procedures 31368 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 64416 NCCI Misuse of Column 2 code with Column 1 code 31368 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31368 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 51 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31368 92502 NCCI NCCI Standards of medical / surgical practice 31368 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31370 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31370 31370 BCBST 31370 31390 NCCI NCCI Mutually exclusive procedures 31370 31395 NCCI NCCI Mutually exclusive procedures 31370 31505 NCCI NCCI Standards of medical / surgical practice 31370 31510 NCCI NCCI Standards of medical / surgical practice 31370 31511 NCCI NCCI Standards of medical / surgical practice 31370 31512 NCCI NCCI Standards of medical / surgical practice 31370 31513 NCCI NCCI Standards of medical / surgical practice 31370 31515 NCCI NCCI Standards of medical / surgical practice 31370 31520 NCCI NCCI Standards of medical / surgical practice 31370 31525 NCCI NCCI Sequential procedures 31370 31526 NCCI NCCI Sequential procedures 31370 31527 NCCI NCCI Standards of medical / surgical practice 31370 31528 NCCI NCCI Standards of medical / surgical practice 31370 31529 NCCI NCCI Standards of medical / surgical practice 31370 31530 NCCI NCCI Standards of medical / surgical practice 31370 31531 NCCI NCCI Standards of medical / surgical practice 31370 31536 NCCI NCCI Standards of medical / surgical practice 31370 31540 NCCI NCCI Standards of medical / surgical practice 31370 31541 NCCI NCCI Standards of medical / surgical practice 31370 31560 NCCI NCCI Standards of medical / surgical practice 31370 31561 NCCI NCCI Standards of medical / surgical practice 31370 31570 NCCI NCCI Standards of medical / surgical practice 31370 31571 NCCI NCCI Standards of medical / surgical practice 31370 31575 NCCI NCCI Standards of medical / surgical practice 31370 31576 NCCI NCCI Standards of medical / surgical practice 31370 31577 NCCI NCCI Standards of medical / surgical practice 31370 31578 NCCI NCCI Standards of medical / surgical practice 31370 31579 NCCI NCCI Most extensive procedures 31370 31595 NCCI NCCI Standards of medical / surgical practice 31370 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31370 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 52 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31370 64416 NCCI Misuse of Column 2 code with Column 1 code 31370 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31370 90780 NCCI NCCI Standards of medical / surgical practice 31370 92502 NCCI NCCI Standards of medical / surgical practice 31370 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31375 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31375 31370 NCCI NCCI Mutually exclusive procedures 31375 31375 BCBST 31375 31390 NCCI NCCI Mutually exclusive procedures 31375 31395 NCCI NCCI Mutually exclusive procedures 31375 31505 NCCI NCCI Standards of medical / surgical practice 31375 31510 NCCI NCCI Standards of medical / surgical practice 31375 31511 NCCI NCCI Standards of medical / surgical practice 31375 31512 NCCI NCCI Standards of medical / surgical practice 31375 31513 NCCI NCCI Standards of medical / surgical practice 31375 31515 NCCI NCCI Standards of medical / surgical practice 31375 31520 NCCI NCCI Standards of medical / surgical practice 31375 31525 NCCI NCCI Sequential procedures 31375 31526 NCCI NCCI Sequential procedures 31375 31527 NCCI NCCI Standards of medical / surgical practice 31375 31528 NCCI NCCI Standards of medical / surgical practice 31375 31529 NCCI NCCI Standards of medical / surgical practice 31375 31530 NCCI NCCI Standards of medical / surgical practice 31375 31531 NCCI NCCI Standards of medical / surgical practice 31375 31536 NCCI NCCI Standards of medical / surgical practice 31375 31540 NCCI NCCI Standards of medical / surgical practice 31375 31541 NCCI NCCI Standards of medical / surgical practice 31375 31560 NCCI NCCI Standards of medical / surgical practice 31375 31561 NCCI NCCI Standards of medical / surgical practice 31375 31570 NCCI NCCI Standards of medical / surgical practice 31375 31571 NCCI NCCI Standards of medical / surgical practice 31375 31575 NCCI NCCI Standards of medical / surgical practice 31375 31576 NCCI NCCI Standards of medical / surgical practice 31375 31577 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 53 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31375 31578 NCCI NCCI Standards of medical / surgical practice 31375 31579 NCCI NCCI Most extensive procedures 31375 31595 NCCI NCCI Standards of medical / surgical practice 31375 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31375 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 64416 NCCI Misuse of Column 2 code with Column 1 code 31375 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31375 90780 NCCI NCCI Standards of medical / surgical practice 31375 92502 NCCI NCCI Standards of medical / surgical practice 31375 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31380 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31380 31370 NCCI NCCI Mutually exclusive procedures 31380 31380 BCBST 31380 31390 NCCI NCCI Mutually exclusive procedures 31380 31395 NCCI NCCI Mutually exclusive procedures 31380 31505 NCCI NCCI Standards of medical / surgical practice 31380 31510 NCCI NCCI Standards of medical / surgical practice 31380 31511 NCCI NCCI Standards of medical / surgical practice 31380 31512 NCCI NCCI Standards of medical / surgical practice 31380 31513 NCCI NCCI Standards of medical / surgical practice 31380 31515 NCCI NCCI Standards of medical / surgical practice 31380 31520 NCCI NCCI Standards of medical / surgical practice 31380 31525 NCCI NCCI Sequential procedures 31380 31526 NCCI NCCI Sequential procedures 31380 31527 NCCI NCCI Standards of medical / surgical practice 31380 31528 NCCI NCCI Standards of medical / surgical practice 31380 31529 NCCI NCCI Standards of medical / surgical practice 31380 31530 NCCI NCCI Standards of medical / surgical practice 31380 31531 NCCI NCCI Standards of medical / surgical practice 31380 31536 NCCI NCCI Standards of medical / surgical practice 31380 31540 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 54 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31380 31541 NCCI NCCI Standards of medical / surgical practice 31380 31560 NCCI NCCI Standards of medical / surgical practice 31380 31561 NCCI NCCI Standards of medical / surgical practice 31380 31570 NCCI NCCI Standards of medical / surgical practice 31380 31571 NCCI NCCI Standards of medical / surgical practice 31380 31575 NCCI NCCI Standards of medical / surgical practice 31380 31576 NCCI NCCI Standards of medical / surgical practice 31380 31577 NCCI NCCI Standards of medical / surgical practice 31380 31578 NCCI NCCI Standards of medical / surgical practice 31380 31579 NCCI NCCI Most extensive procedures 31380 31595 NCCI NCCI Standards of medical / surgical practice 31380 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31380 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 64416 NCCI Misuse of Column 2 code with Column 1 code 31380 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31380 90780 NCCI NCCI Standards of medical / surgical practice 31380 92502 NCCI NCCI Standards of medical / surgical practice 31380 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31382 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31382 31370 NCCI NCCI Mutually exclusive procedures 31382 31375 NCCI NCCI HCPCS/CPT procedure code definition 31382 31380 NCCI NCCI HCPCS/CPT procedure code definition 31382 31382 BCBST 31382 31390 NCCI NCCI Mutually exclusive procedures 31382 31395 NCCI NCCI Mutually exclusive procedures 31382 31505 NCCI NCCI Standards of medical / surgical practice 31382 31510 NCCI NCCI Standards of medical / surgical practice 31382 31511 NCCI NCCI Standards of medical / surgical practice 31382 31512 NCCI NCCI Standards of medical / surgical practice 31382 31513 NCCI NCCI Standards of medical / surgical practice 31382 31515 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 55 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31382 31520 NCCI NCCI Standards of medical / surgical practice 31382 31525 NCCI NCCI Standards of medical / surgical practice 31382 31526 NCCI NCCI Standards of medical / surgical practice 31382 31527 NCCI NCCI Standards of medical / surgical practice 31382 31528 NCCI NCCI Standards of medical / surgical practice 31382 31529 NCCI NCCI Standards of medical / surgical practice 31382 31530 NCCI NCCI Standards of medical / surgical practice 31382 31531 NCCI NCCI Standards of medical / surgical practice 31382 31536 NCCI NCCI Standards of medical / surgical practice 31382 31540 NCCI NCCI Standards of medical / surgical practice 31382 31541 NCCI NCCI Standards of medical / surgical practice 31382 31560 NCCI NCCI Standards of medical / surgical practice 31382 31561 NCCI NCCI Standards of medical / surgical practice 31382 31570 NCCI NCCI Standards of medical / surgical practice 31382 31571 NCCI NCCI Standards of medical / surgical practice 31382 31575 NCCI NCCI Standards of medical / surgical practice 31382 31576 NCCI NCCI Standards of medical / surgical practice 31382 31577 NCCI NCCI Standards of medical / surgical practice 31382 31578 NCCI NCCI Standards of medical / surgical practice 31382 31579 NCCI NCCI Most extensive procedures 31382 31595 NCCI NCCI Standards of medical / surgical practice 31382 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31382 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 64416 NCCI Misuse of Column 2 code with Column 1 code 31382 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31382 90780 NCCI NCCI Standards of medical / surgical practice 31382 92502 NCCI NCCI Standards of medical / surgical practice 31382 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31390 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31390 31365 NCCI NCCI Mutually exclusive procedures 31390 31368 NCCI NCCI Mutually exclusive procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 56 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31390 31390 BCBST Procedure redundant to itself. 31390 31400 NCCI NCCI Most extensive procedures 31390 31420 NCCI NCCI Most extensive procedures 31390 31505 NCCI NCCI Standards of medical / surgical practice 31390 31510 NCCI NCCI Standards of medical / surgical practice 31390 31511 NCCI NCCI Standards of medical / surgical practice 31390 31512 NCCI NCCI Standards of medical / surgical practice 31390 31513 NCCI NCCI Standards of medical / surgical practice 31390 31515 NCCI NCCI Standards of medical / surgical practice 31390 31520 NCCI NCCI Standards of medical / surgical practice 31390 31525 NCCI NCCI Standards of medical / surgical practice 31390 31526 NCCI NCCI Standards of medical / surgical practice 31390 31527 NCCI NCCI Standards of medical / surgical practice 31390 31528 NCCI NCCI Standards of medical / surgical practice 31390 31529 NCCI NCCI Standards of medical / surgical practice 31390 31530 NCCI NCCI Standards of medical / surgical practice 31390 31531 NCCI NCCI Standards of medical / surgical practice 31390 31536 NCCI NCCI Standards of medical / surgical practice 31390 31540 NCCI NCCI Standards of medical / surgical practice 31390 31541 NCCI NCCI Standards of medical / surgical practice 31390 31560 NCCI NCCI Standards of medical / surgical practice 31390 31561 NCCI NCCI Standards of medical / surgical practice 31390 31570 NCCI NCCI Standards of medical / surgical practice 31390 31571 NCCI NCCI Standards of medical / surgical practice 31390 31575 NCCI NCCI Standards of medical / surgical practice 31390 31576 NCCI NCCI Standards of medical / surgical practice 31390 31577 NCCI NCCI Standards of medical / surgical practice 31390 31578 NCCI NCCI Standards of medical / surgical practice 31390 31579 NCCI NCCI Most extensive procedures 31390 31595 NCCI NCCI Standards of medical / surgical practice 31390 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31390 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 38720 NCCI NCCI HCPCS/CPT procedure code definition 31390 38724 NCCI NCCI HCPCS/CPT procedure code definition 31390 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 64416 NCCI Misuse of Column 2 code with Column 1 code 31390 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 57 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31390 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31390 90780 NCCI NCCI Standards of medical / surgical practice 31390 92502 NCCI NCCI Standards of medical / surgical practice 31390 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31395 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31395 31390 NCCI NCCI "With" versus "without" procedures 31395 31395 BCBST 31395 31400 NCCI NCCI Most extensive procedures 31395 31420 NCCI NCCI Most extensive procedures 31395 31505 NCCI NCCI Standards of medical / surgical practice 31395 31510 NCCI NCCI Standards of medical / surgical practice 31395 31511 NCCI NCCI Standards of medical / surgical practice 31395 31512 NCCI NCCI Standards of medical / surgical practice 31395 31513 NCCI NCCI Standards of medical / surgical practice 31395 31515 NCCI NCCI Standards of medical / surgical practice 31395 31520 NCCI NCCI Standards of medical / surgical practice 31395 31525 NCCI NCCI Standards of medical / surgical practice 31395 31526 NCCI NCCI Standards of medical / surgical practice 31395 31527 NCCI NCCI Standards of medical / surgical practice 31395 31528 NCCI NCCI Standards of medical / surgical practice 31395 31529 NCCI NCCI Standards of medical / surgical practice 31395 31530 NCCI NCCI Standards of medical / surgical practice 31395 31531 NCCI NCCI Standards of medical / surgical practice 31395 31536 NCCI NCCI Standards of medical / surgical practice 31395 31540 NCCI NCCI Standards of medical / surgical practice 31395 31541 NCCI NCCI Standards of medical / surgical practice 31395 31560 NCCI NCCI Standards of medical / surgical practice 31395 31561 NCCI NCCI Standards of medical / surgical practice 31395 31570 NCCI NCCI Standards of medical / surgical practice 31395 31571 NCCI NCCI Standards of medical / surgical practice 31395 31575 NCCI NCCI Standards of medical / surgical practice 31395 31576 NCCI NCCI Standards of medical / surgical practice 31395 31577 NCCI NCCI Standards of medical / surgical practice 31395 31578 NCCI NCCI Standards of medical / surgical practice 31395 31579 NCCI NCCI Most extensive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 58 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31395 31595 NCCI NCCI Standards of medical / surgical practice 31395 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31395 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 38720 NCCI NCCI HCPCS/CPT procedure code definition 31395 38724 NCCI NCCI HCPCS/CPT procedure code definition 31395 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 64416 NCCI Misuse of Column 2 code with Column 1 code 31395 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31395 90780 NCCI NCCI Standards of medical / surgical practice 31395 92502 NCCI NCCI Standards of medical / surgical practice 31395 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31400 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31400 31400 BCBST 31400 31505 NCCI NCCI Standards of medical / surgical practice 31400 31510 NCCI NCCI Standards of medical / surgical practice 31400 31511 NCCI NCCI Standards of medical / surgical practice 31400 31512 NCCI NCCI Standards of medical / surgical practice 31400 31513 NCCI NCCI Standards of medical / surgical practice 31400 31515 NCCI NCCI Standards of medical / surgical practice 31400 31520 NCCI NCCI Standards of medical / surgical practice 31400 31525 NCCI NCCI Standards of medical / surgical practice 31400 31526 NCCI NCCI Standards of medical / surgical practice 31400 31527 NCCI NCCI Standards of medical / surgical practice 31400 31528 NCCI NCCI Standards of medical / surgical practice 31400 31529 NCCI NCCI Standards of medical / surgical practice 31400 31530 NCCI NCCI Standards of medical / surgical practice 31400 31531 NCCI NCCI Standards of medical / surgical practice 31400 31536 NCCI NCCI Standards of medical / surgical practice 31400 31540 NCCI NCCI Standards of medical / surgical practice 31400 31541 NCCI NCCI Standards of medical / surgical practice 31400 31560 NCCI NCCI Standards of medical / surgical practice 31400 31561 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 59 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31400 31570 NCCI NCCI Standards of medical / surgical practice 31400 31571 NCCI NCCI Standards of medical / surgical practice 31400 31575 NCCI NCCI Standards of medical / surgical practice 31400 31576 NCCI NCCI Standards of medical / surgical practice 31400 31577 NCCI NCCI Standards of medical / surgical practice 31400 31578 NCCI NCCI Standards of medical / surgical practice 31400 31579 NCCI NCCI Most extensive procedures 31400 31595 NCCI NCCI Standards of medical / surgical practice 31400 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 64416 NCCI Misuse of Column 2 code with Column 1 code 31400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31400 90780 NCCI NCCI Standards of medical / surgical practice 31400 92502 NCCI NCCI Standards of medical / surgical practice 31400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31420 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31420 31320 NCCI NCCI Sequential procedures 31420 31420 BCBST 31420 31505 NCCI NCCI Standards of medical / surgical practice 31420 31510 NCCI NCCI Standards of medical / surgical practice 31420 31511 NCCI NCCI Standards of medical / surgical practice 31420 31512 NCCI NCCI Standards of medical / surgical practice 31420 31513 NCCI NCCI Standards of medical / surgical practice 31420 31515 NCCI NCCI Standards of medical / surgical practice 31420 31520 NCCI NCCI Standards of medical / surgical practice 31420 31525 NCCI NCCI Standards of medical / surgical practice 31420 31526 NCCI NCCI Standards of medical / surgical practice 31420 31527 NCCI NCCI Standards of medical / surgical practice 31420 31528 NCCI NCCI Standards of medical / surgical practice 31420 31529 NCCI NCCI Standards of medical / surgical practice 31420 31530 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 60 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31420 31531 NCCI NCCI Standards of medical / surgical practice 31420 31536 NCCI NCCI Standards of medical / surgical practice 31420 31540 NCCI NCCI Standards of medical / surgical practice 31420 31541 NCCI NCCI Standards of medical / surgical practice 31420 31560 NCCI NCCI Standards of medical / surgical practice 31420 31561 NCCI NCCI Standards of medical / surgical practice 31420 31570 NCCI NCCI Standards of medical / surgical practice 31420 31571 NCCI NCCI Standards of medical / surgical practice 31420 31575 NCCI NCCI Standards of medical / surgical practice 31420 31576 NCCI NCCI Standards of medical / surgical practice 31420 31577 NCCI NCCI Standards of medical / surgical practice 31420 31578 NCCI NCCI Standards of medical / surgical practice 31420 31579 NCCI NCCI Most extensive procedures 31420 31595 NCCI NCCI Standards of medical / surgical practice 31420 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 64416 NCCI Misuse of Column 2 code with Column 1 code 31420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31420 90780 NCCI NCCI Standards of medical / surgical practice 31420 92502 NCCI NCCI Standards of medical / surgical practice 31420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31500 00320 NCCI Anesthesia included in surgical procedures 31500 00326 NCCI Anesthesia included in surgical procedures 31500 31500 BCBST 31500 31505 NCCI NCCI Standards of medical / surgical practice 31500 31510 NCCI NCCI Standards of medical / surgical practice 31500 31511 NCCI NCCI Standards of medical / surgical practice 31500 31512 NCCI NCCI Standards of medical / surgical practice 31500 31513 NCCI NCCI Standards of medical / surgical practice 31500 31515 NCCI NCCI Standards of medical / surgical practice 31500 31520 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 61 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31500 31525 NCCI NCCI Standards of medical / surgical practice 31500 31526 NCCI NCCI Standards of medical / surgical practice 31500 31527 NCCI NCCI Standards of medical / surgical practice 31500 31528 NCCI NCCI Standards of medical / surgical practice 31500 31529 NCCI NCCI Standards of medical / surgical practice 31500 31530 NCCI NCCI Standards of medical / surgical practice 31500 31531 NCCI NCCI Standards of medical / surgical practice 31500 31536 NCCI NCCI Standards of medical / surgical practice 31500 31540 NCCI NCCI Standards of medical / surgical practice 31500 31541 NCCI NCCI Standards of medical / surgical practice 31500 31560 NCCI NCCI Standards of medical / surgical practice 31500 31561 NCCI NCCI Standards of medical / surgical practice 31500 31570 NCCI NCCI Standards of medical / surgical practice 31500 31571 NCCI NCCI Standards of medical / surgical practice 31500 31575 NCCI NCCI Standards of medical / surgical practice 31500 31576 NCCI NCCI Standards of medical / surgical practice 31500 31577 NCCI NCCI Standards of medical / surgical practice 31500 31578 NCCI NCCI Standards of medical / surgical practice 31500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 64416 NCCI Misuse of Column 2 code with Column 1 code 31500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31500 90780 NCCI NCCI Standards of medical / surgical practice 31500 92502 NCCI NCCI Standards of medical / surgical practice 31500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31502 00320 NCCI Anesthesia included in surgical procedures 31502 00326 NCCI Anesthesia included in surgical procedures 31502 31502 BCBST 31502 31505 NCCI NCCI Standards of medical / surgical practice 31502 31510 NCCI NCCI Standards of medical / surgical practice 31502 31511 NCCI NCCI Standards of medical / surgical practice 31502 31512 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 62 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31502 31513 NCCI NCCI Standards of medical / surgical practice 31502 31515 NCCI NCCI Standards of medical / surgical practice 31502 31520 NCCI NCCI Standards of medical / surgical practice 31502 31525 NCCI NCCI Standards of medical / surgical practice 31502 31526 NCCI NCCI Standards of medical / surgical practice 31502 31527 NCCI NCCI Standards of medical / surgical practice 31502 31528 NCCI NCCI Standards of medical / surgical practice 31502 31529 NCCI NCCI Standards of medical / surgical practice 31502 31530 NCCI NCCI Standards of medical / surgical practice 31502 31531 NCCI NCCI Standards of medical / surgical practice 31502 31536 NCCI NCCI Standards of medical / surgical practice 31502 31540 NCCI NCCI Standards of medical / surgical practice 31502 31541 NCCI NCCI Standards of medical / surgical practice 31502 31560 NCCI NCCI Standards of medical / surgical practice 31502 31561 NCCI NCCI Standards of medical / surgical practice 31502 31570 NCCI NCCI Standards of medical / surgical practice 31502 31571 NCCI NCCI Standards of medical / surgical practice 31502 31575 NCCI NCCI Standards of medical / surgical practice 31502 31576 NCCI NCCI Standards of medical / surgical practice 31502 31577 NCCI NCCI Standards of medical / surgical practice 31502 31578 NCCI NCCI Standards of medical / surgical practice 31502 31603 NCCI NCCI Mutually exclusive procedures 31502 31605 NCCI NCCI Mutually exclusive procedures 31502 31610 NCCI NCCI Mutually exclusive procedures 31502 31611 NCCI NCCI Mutually exclusive procedures 31502 31612 NCCI NCCI Mutually exclusive procedures 31502 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 64416 NCCI Misuse of Column 2 code with Column 1 code 31502 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31502 90780 NCCI NCCI Standards of medical / surgical practice 31502 92502 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 63 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31502 S0020 31505 31505 Source Rationale CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 00326 NCCI Anesthesia included in surgical procedures 31505 BCBST 31505 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 64416 NCCI Misuse of Column 2 code with Column 1 code 31505 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31505 90780 NCCI NCCI Standards of medical / surgical practice 31505 92502 NCCI NCCI Standards of medical / surgical practice 31505 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31510 00320 NCCI Anesthesia included in surgical procedures 31510 00326 NCCI Anesthesia included in surgical procedures 31510 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31510 31510 BCBST 31510 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 64416 NCCI Misuse of Column 2 code with Column 1 code 31510 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31510 90780 NCCI NCCI Standards of medical / surgical practice 31510 92502 NCCI NCCI Standards of medical / surgical practice 31510 92511 NCCI NCCI Most extensive procedures 31510 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31511 00320 NCCI Anesthesia included in surgical procedures 31511 00326 NCCI Anesthesia included in surgical procedures 31511 31505 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 64 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31511 31511 BCBST Procedure redundant to itself. 31511 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 64416 NCCI Misuse of Column 2 code with Column 1 code 31511 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31511 90780 NCCI NCCI Standards of medical / surgical practice 31511 92502 NCCI NCCI Standards of medical / surgical practice 31511 92511 NCCI NCCI Most extensive procedures 31511 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31512 00320 NCCI Anesthesia included in surgical procedures 31512 00326 NCCI Anesthesia included in surgical procedures 31512 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31512 31510 NCCI NCCI Most extensive procedures 31512 31512 BCBST 31512 31576 NCCI NCCI Most extensive procedures 31512 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 64416 NCCI Misuse of Column 2 code with Column 1 code 31512 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31512 90780 NCCI NCCI Standards of medical / surgical practice 31512 92502 NCCI NCCI Standards of medical / surgical practice 31512 92511 NCCI NCCI Most extensive procedures 31512 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31513 00320 NCCI Anesthesia included in surgical procedures 31513 00326 NCCI Anesthesia included in surgical procedures 31513 31505 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 65 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31513 31513 BCBST Procedure redundant to itself. 31513 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 64416 NCCI Misuse of Column 2 code with Column 1 code 31513 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31513 90780 NCCI NCCI Standards of medical / surgical practice 31513 92502 NCCI NCCI Standards of medical / surgical practice 31513 92511 NCCI NCCI Most extensive procedures 31513 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31515 00326 NCCI Anesthesia included in surgical procedures 31515 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31515 31515 BCBST 31515 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 64416 NCCI Misuse of Column 2 code with Column 1 code 31515 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31515 90780 NCCI NCCI Standards of medical / surgical practice 31515 92502 NCCI NCCI Standards of medical / surgical practice 31515 92511 NCCI NCCI Most extensive procedures 31515 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31520 00320 NCCI Anesthesia included in surgical procedures 31520 00326 NCCI Anesthesia included in surgical procedures 31520 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31520 31520 BCBST 31520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 66 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 64416 NCCI Misuse of Column 2 code with Column 1 code 31520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31520 90780 NCCI NCCI Standards of medical / surgical practice 31520 92502 NCCI NCCI Standards of medical / surgical practice 31520 92511 NCCI NCCI Most extensive procedures 31520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31525 00320 NCCI Anesthesia included in surgical procedures 31525 00326 NCCI Anesthesia included in surgical procedures 31525 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31525 31525 BCBST 31525 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 42800 NCCI NCCI Standards of medical / surgical practice 31525 42806 NCCI NCCI Standards of medical / surgical practice 31525 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 64416 NCCI Misuse of Column 2 code with Column 1 code 31525 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31525 90780 NCCI NCCI Standards of medical / surgical practice 31525 92502 NCCI NCCI Standards of medical / surgical practice 31525 92511 NCCI NCCI Most extensive procedures 31525 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31526 00320 NCCI Anesthesia included in surgical procedures 31526 00326 NCCI Anesthesia included in surgical procedures 31526 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31526 31526 BCBST 31526 31656 NCCI NCCI Most extensive procedures 31526 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 67 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31526 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 64416 NCCI Misuse of Column 2 code with Column 1 code 31526 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31526 90780 NCCI NCCI Standards of medical / surgical practice 31526 92502 NCCI NCCI Standards of medical / surgical practice 31526 92511 NCCI NCCI Most extensive procedures 31526 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31527 00326 NCCI Anesthesia included in surgical procedures 31527 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31527 31527 BCBST 31527 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 64416 NCCI Misuse of Column 2 code with Column 1 code 31527 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31527 90780 NCCI NCCI Standards of medical / surgical practice 31527 92502 NCCI NCCI Standards of medical / surgical practice 31527 92511 NCCI NCCI Most extensive procedures 31527 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31528 00320 NCCI Anesthesia included in surgical procedures 31528 00326 NCCI Anesthesia included in surgical procedures 31528 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31528 31528 BCBST 31528 31529 NCCI NCCI Mutually exclusive procedures 31528 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 68 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31528 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 64416 NCCI Misuse of Column 2 code with Column 1 code 31528 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31528 90780 NCCI NCCI Standards of medical / surgical practice 31528 92502 NCCI NCCI Standards of medical / surgical practice 31528 92511 NCCI NCCI Most extensive procedures 31528 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31529 00320 NCCI Anesthesia included in surgical procedures 31529 00326 NCCI Anesthesia included in surgical procedures 31529 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31529 31529 BCBST 31529 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 64416 NCCI Misuse of Column 2 code with Column 1 code 31529 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31529 90780 NCCI NCCI Standards of medical / surgical practice 31529 92502 NCCI NCCI Standards of medical / surgical practice 31529 92511 NCCI NCCI Most extensive procedures 31529 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31530 00320 NCCI Anesthesia included in surgical procedures 31530 00326 NCCI Anesthesia included in surgical procedures 31530 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31530 31525 NCCI NCCI Standards of medical / surgical practice 31530 31530 BCBST 31530 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 69 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31530 64416 NCCI Misuse of Column 2 code with Column 1 code 31530 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31530 90780 NCCI NCCI Standards of medical / surgical practice 31530 92502 NCCI NCCI Standards of medical / surgical practice 31530 92511 NCCI NCCI Most extensive procedures 31530 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31531 00320 NCCI Anesthesia included in surgical procedures 31531 00326 NCCI Anesthesia included in surgical procedures 31531 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31531 31525 NCCI NCCI Standards of medical / surgical practice 31531 31530 NCCI NCCI HCPCS/CPT procedure code definition 31531 31531 BCBST 31531 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 64416 NCCI Misuse of Column 2 code with Column 1 code 31531 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31531 90780 NCCI NCCI Standards of medical / surgical practice 31531 92502 NCCI NCCI Standards of medical / surgical practice 31531 92511 NCCI NCCI Most extensive procedures 31535 00320 NCCI Anesthesia included in surgical procedures 31535 00326 NCCI Anesthesia included in surgical procedures 31535 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31535 31525 NCCI NCCI Standards of medical / surgical practice 31535 31535 BCBST 31535 35800 NCCI NCCI Standards of medical / surgical practice 31535 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 42806 NCCI NCCI Most extensive procedures 31535 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 70 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31535 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 64416 NCCI Misuse of Column 2 code with Column 1 code 31535 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31535 90780 NCCI NCCI Standards of medical / surgical practice 31535 92502 NCCI NCCI Standards of medical / surgical practice 31535 92511 NCCI NCCI Most extensive procedures 31535 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31536 00320 NCCI Anesthesia included in surgical procedures 31536 00326 NCCI Anesthesia included in surgical procedures 31536 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31536 31525 NCCI NCCI Standards of medical / surgical practice 31536 31535 NCCI NCCI HCPCS/CPT procedure code definition 31536 31536 BCBST 31536 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 42806 NCCI NCCI Most extensive procedures 31536 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 64416 NCCI Misuse of Column 2 code with Column 1 code 31536 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31536 90780 NCCI NCCI Standards of medical / surgical practice 31536 92502 NCCI NCCI Standards of medical / surgical practice 31536 92511 NCCI NCCI Most extensive procedures 31536 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31540 00320 NCCI Anesthesia included in surgical procedures 31540 00326 NCCI Anesthesia included in surgical procedures 31540 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31540 31510 NCCI NCCI Most extensive procedures 31540 31510 NCCI NCCI Most extensive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 71 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31540 31525 NCCI NCCI Standards of medical / surgical practice 31540 31535 NCCI NCCI Most extensive procedures 31540 31536 NCCI NCCI Most extensive procedures 31540 31540 BCBST 31540 31576 NCCI NCCI Most extensive procedures 31540 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 64416 NCCI Misuse of Column 2 code with Column 1 code 31540 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31540 90780 NCCI NCCI Standards of medical / surgical practice 31540 92502 NCCI NCCI Standards of medical / surgical practice 31540 92511 NCCI NCCI Most extensive procedures 31540 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31541 00320 NCCI Anesthesia included in surgical procedures 31541 00326 NCCI Anesthesia included in surgical procedures 31541 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31541 31510 NCCI NCCI Most extensive procedures 31541 31510 NCCI NCCI Most extensive procedures 31541 31525 NCCI NCCI Standards of medical / surgical practice 31541 31535 NCCI NCCI Most extensive procedures 31541 31536 NCCI NCCI Most extensive procedures 31541 31540 NCCI NCCI HCPCS/CPT procedure code definition 31541 31541 BCBST 31541 31576 NCCI NCCI Most extensive procedures 31541 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 64416 NCCI Misuse of Column 2 code with Column 1 code 31541 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 72 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31541 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31541 90780 NCCI NCCI Standards of medical / surgical practice 31541 92502 NCCI NCCI Standards of medical / surgical practice 31541 92511 NCCI NCCI Most extensive procedures 31541 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31560 00320 NCCI Anesthesia included in surgical procedures 31560 00326 NCCI Anesthesia included in surgical procedures 31560 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31560 31525 NCCI NCCI Standards of medical / surgical practice 31560 31560 BCBST 31560 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 64416 NCCI Misuse of Column 2 code with Column 1 code 31560 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31560 90780 NCCI NCCI Standards of medical / surgical practice 31560 92502 NCCI NCCI Standards of medical / surgical practice 31560 92511 NCCI NCCI Most extensive procedures 31560 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31561 00320 NCCI Anesthesia included in surgical procedures 31561 00326 NCCI Anesthesia included in surgical procedures 31561 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31561 31525 NCCI NCCI Standards of medical / surgical practice 31561 31560 NCCI NCCI HCPCS/CPT procedure code definition 31561 31561 BCBST 31561 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 64416 NCCI Misuse of Column 2 code with Column 1 code 31561 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 73 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31561 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31561 90780 NCCI NCCI Standards of medical / surgical practice 31561 92502 NCCI NCCI Standards of medical / surgical practice 31561 92511 NCCI NCCI Most extensive procedures 31561 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31570 00320 NCCI Anesthesia included in surgical procedures 31570 00326 NCCI Anesthesia included in surgical procedures 31570 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31570 31570 BCBST 31570 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 64416 NCCI Misuse of Column 2 code with Column 1 code 31570 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31570 90780 NCCI NCCI Standards of medical / surgical practice 31570 92502 NCCI NCCI Standards of medical / surgical practice 31570 92511 NCCI NCCI Most extensive procedures 31570 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31571 00320 NCCI Anesthesia included in surgical procedures 31571 00326 NCCI Anesthesia included in surgical procedures 31571 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31571 31570 NCCI NCCI HCPCS/CPT procedure code definition 31571 31571 BCBST 31571 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 64416 NCCI Misuse of Column 2 code with Column 1 code 31571 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 74 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31571 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31571 90780 NCCI NCCI Standards of medical / surgical practice 31571 92502 NCCI NCCI Standards of medical / surgical practice 31571 92511 NCCI NCCI Most extensive procedures 31571 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31575 00320 NCCI Anesthesia included in surgical procedures 31575 00326 NCCI Anesthesia included in surgical procedures 31575 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31575 31515 NCCI NCCI Mutually exclusive procedures 31575 31575 BCBST 31575 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 64416 NCCI Misuse of Column 2 code with Column 1 code 31575 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31575 90780 NCCI NCCI Standards of medical / surgical practice 31575 92502 NCCI NCCI Standards of medical / surgical practice 31575 92511 NCCI NCCI Most extensive procedures 31575 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31576 00320 NCCI Anesthesia included in surgical procedures 31576 00326 NCCI Anesthesia included in surgical procedures 31576 30901 NCCI NCCI Most extensive procedures 31576 30903 NCCI NCCI Most extensive procedures 31576 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31576 31576 BCBST 31576 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 64416 NCCI Misuse of Column 2 code with Column 1 code 31576 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 75 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31576 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31576 90780 NCCI NCCI Standards of medical / surgical practice 31576 92502 NCCI NCCI Standards of medical / surgical practice 31576 92511 NCCI NCCI Most extensive procedures 31576 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31577 00320 NCCI Anesthesia included in surgical procedures 31577 00326 NCCI Anesthesia included in surgical procedures 31577 30901 NCCI NCCI Most extensive procedures 31577 30903 NCCI NCCI Most extensive procedures 31577 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31577 31530 NCCI NCCI Mutually exclusive procedures 31577 31531 NCCI NCCI Mutually exclusive procedures 31577 31577 BCBST 31577 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 64416 NCCI Misuse of Column 2 code with Column 1 code 31577 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31577 90780 NCCI NCCI Standards of medical / surgical practice 31577 92502 NCCI NCCI Standards of medical / surgical practice 31577 92511 NCCI NCCI Most extensive procedures 31577 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31578 00320 NCCI Anesthesia included in surgical procedures 31578 00326 NCCI Anesthesia included in surgical procedures 31578 30901 NCCI NCCI Most extensive procedures 31578 30903 NCCI NCCI Most extensive procedures 31578 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31578 31510 NCCI NCCI Most extensive procedures 31578 31510 NCCI NCCI Most extensive procedures 31578 31535 NCCI NCCI Most extensive procedures 31578 31536 NCCI NCCI Most extensive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 76 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31578 31540 NCCI NCCI Mutually exclusive procedures 31578 31541 NCCI NCCI Mutually exclusive procedures 31578 31576 NCCI NCCI Most extensive procedures 31578 31578 BCBST 31578 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 64416 NCCI Misuse of Column 2 code with Column 1 code 31578 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31578 90780 NCCI NCCI Standards of medical / surgical practice 31578 92502 NCCI NCCI Standards of medical / surgical practice 31578 92511 NCCI NCCI Most extensive procedures 31578 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31579 00320 NCCI Anesthesia included in surgical procedures 31579 00326 NCCI Anesthesia included in surgical procedures 31579 30901 NCCI NCCI Most extensive procedures 31579 30903 NCCI NCCI Most extensive procedures 31579 31505 NCCI NCCI HCPCS/CPT separate procedure definition 31579 31525 NCCI NCCI Mutually exclusive procedures 31579 31579 BCBST 31579 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 64416 NCCI Misuse of Column 2 code with Column 1 code 31579 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31579 70371 NCCI NCCI Most extensive procedures 31579 90780 NCCI NCCI Standards of medical / surgical practice 31579 92502 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 77 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31579 Source Rationale 92511 NCCI 31579 92520 NCCI NCCI Most extensive procedures 31579 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31580 00320 NCCI Anesthesia included in surgical procedures 31580 00326 NCCI Anesthesia included in surgical procedures 31580 31505 NCCI NCCI Standards of medical / surgical practice 31580 31510 NCCI NCCI Standards of medical / surgical practice 31580 31511 NCCI NCCI Standards of medical / surgical practice 31580 31512 NCCI NCCI Standards of medical / surgical practice 31580 31513 NCCI NCCI Standards of medical / surgical practice 31580 31515 NCCI NCCI Standards of medical / surgical practice 31580 31520 NCCI NCCI Standards of medical / surgical practice 31580 31525 NCCI NCCI Sequential procedures 31580 31526 NCCI NCCI Sequential procedures 31580 31527 NCCI NCCI Standards of medical / surgical practice 31580 31528 NCCI NCCI Standards of medical / surgical practice 31580 31529 NCCI NCCI Standards of medical / surgical practice 31580 31530 NCCI NCCI Standards of medical / surgical practice 31580 31531 NCCI NCCI Standards of medical / surgical practice 31580 31536 NCCI NCCI Standards of medical / surgical practice 31580 31540 NCCI NCCI Standards of medical / surgical practice 31580 31541 NCCI NCCI Standards of medical / surgical practice 31580 31560 NCCI NCCI Standards of medical / surgical practice 31580 31561 NCCI NCCI Standards of medical / surgical practice 31580 31570 NCCI NCCI Standards of medical / surgical practice 31580 31571 NCCI NCCI Standards of medical / surgical practice 31580 31575 NCCI NCCI Sequential procedures 31580 31576 NCCI NCCI Standards of medical / surgical practice 31580 31577 NCCI NCCI Standards of medical / surgical practice 31580 31578 NCCI NCCI Standards of medical / surgical practice 31580 31579 NCCI NCCI Most extensive procedures 31580 31580 BCBST 31580 31582 NCCI NCCI Most extensive procedures 31580 31584 NCCI NCCI Mutually exclusive procedures 31580 31588 NCCI NCCI Mutually exclusive procedures 31580 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31580 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 78 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31580 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 64416 NCCI Misuse of Column 2 code with Column 1 code 31580 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31580 90780 NCCI NCCI Standards of medical / surgical practice 31580 92502 NCCI NCCI Standards of medical / surgical practice 31580 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31582 00320 NCCI Anesthesia included in surgical procedures 31582 00326 NCCI Anesthesia included in surgical procedures 31582 31505 NCCI NCCI Standards of medical / surgical practice 31582 31510 NCCI NCCI Standards of medical / surgical practice 31582 31511 NCCI NCCI Standards of medical / surgical practice 31582 31512 NCCI NCCI Standards of medical / surgical practice 31582 31513 NCCI NCCI Standards of medical / surgical practice 31582 31515 NCCI NCCI Standards of medical / surgical practice 31582 31520 NCCI NCCI Standards of medical / surgical practice 31582 31525 NCCI NCCI Sequential procedures 31582 31526 NCCI NCCI Sequential procedures 31582 31527 NCCI NCCI Standards of medical / surgical practice 31582 31528 NCCI NCCI Standards of medical / surgical practice 31582 31529 NCCI NCCI Standards of medical / surgical practice 31582 31530 NCCI NCCI Standards of medical / surgical practice 31582 31531 NCCI NCCI Standards of medical / surgical practice 31582 31536 NCCI NCCI Standards of medical / surgical practice 31582 31540 NCCI NCCI Standards of medical / surgical practice 31582 31541 NCCI NCCI Standards of medical / surgical practice 31582 31560 NCCI NCCI Standards of medical / surgical practice 31582 31561 NCCI NCCI Standards of medical / surgical practice 31582 31570 NCCI NCCI Standards of medical / surgical practice 31582 31571 NCCI NCCI Standards of medical / surgical practice 31582 31575 NCCI NCCI Sequential procedures 31582 31576 NCCI NCCI Standards of medical / surgical practice 31582 31577 NCCI NCCI Standards of medical / surgical practice 31582 31578 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 79 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31582 31579 NCCI 31582 31582 BCBST 31582 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31582 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 64416 NCCI Misuse of Column 2 code with Column 1 code 31582 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31582 90780 NCCI NCCI Standards of medical / surgical practice 31582 92502 NCCI NCCI Standards of medical / surgical practice 31582 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31584 00320 NCCI Anesthesia included in surgical procedures 31584 00326 NCCI Anesthesia included in surgical procedures 31584 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31584 31505 NCCI NCCI Standards of medical / surgical practice 31584 31510 NCCI NCCI Standards of medical / surgical practice 31584 31511 NCCI NCCI Standards of medical / surgical practice 31584 31512 NCCI NCCI Standards of medical / surgical practice 31584 31513 NCCI NCCI Standards of medical / surgical practice 31584 31515 NCCI NCCI Standards of medical / surgical practice 31584 31520 NCCI NCCI Standards of medical / surgical practice 31584 31525 NCCI NCCI Sequential procedures 31584 31526 NCCI NCCI Sequential procedures 31584 31527 NCCI NCCI Standards of medical / surgical practice 31584 31528 NCCI NCCI Standards of medical / surgical practice 31584 31529 NCCI NCCI Standards of medical / surgical practice 31584 31530 NCCI NCCI Standards of medical / surgical practice 31584 31531 NCCI NCCI Standards of medical / surgical practice 31584 31536 NCCI NCCI Standards of medical / surgical practice 31584 31540 NCCI NCCI Standards of medical / surgical practice 31584 31541 NCCI NCCI Standards of medical / surgical practice 31584 31560 NCCI NCCI Standards of medical / surgical practice 31584 31561 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI Most extensive procedures Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 80 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31584 31570 NCCI NCCI Standards of medical / surgical practice 31584 31571 NCCI NCCI Standards of medical / surgical practice 31584 31575 NCCI NCCI Sequential procedures 31584 31576 NCCI NCCI Standards of medical / surgical practice 31584 31577 NCCI NCCI Standards of medical / surgical practice 31584 31578 NCCI NCCI Standards of medical / surgical practice 31584 31579 NCCI NCCI Most extensive procedures 31584 31584 BCBST 31584 31595 NCCI NCCI HCPCS/CPT separate procedure definition 31584 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31584 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 64416 NCCI Misuse of Column 2 code with Column 1 code 31584 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31584 90780 NCCI NCCI Standards of medical / surgical practice 31584 92502 NCCI NCCI Standards of medical / surgical practice 31584 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31585 00320 NCCI Anesthesia included in surgical procedures 31585 00326 NCCI Anesthesia included in surgical procedures 31585 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31585 31505 NCCI NCCI Standards of medical / surgical practice 31585 31510 NCCI NCCI Standards of medical / surgical practice 31585 31511 NCCI NCCI Standards of medical / surgical practice 31585 31512 NCCI NCCI Standards of medical / surgical practice 31585 31513 NCCI NCCI Standards of medical / surgical practice 31585 31515 NCCI NCCI Standards of medical / surgical practice 31585 31520 NCCI NCCI Standards of medical / surgical practice 31585 31525 NCCI NCCI Sequential procedures 31585 31526 NCCI NCCI Sequential procedures 31585 31527 NCCI NCCI Standards of medical / surgical practice 31585 31528 NCCI NCCI Standards of medical / surgical practice 31585 31529 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 81 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31585 31530 NCCI NCCI Standards of medical / surgical practice 31585 31531 NCCI NCCI Standards of medical / surgical practice 31585 31536 NCCI NCCI Standards of medical / surgical practice 31585 31540 NCCI NCCI Standards of medical / surgical practice 31585 31541 NCCI NCCI Standards of medical / surgical practice 31585 31560 NCCI NCCI Standards of medical / surgical practice 31585 31561 NCCI NCCI Standards of medical / surgical practice 31585 31570 NCCI NCCI Standards of medical / surgical practice 31585 31571 NCCI NCCI Standards of medical / surgical practice 31585 31575 NCCI NCCI Sequential procedures 31585 31576 NCCI NCCI Standards of medical / surgical practice 31585 31577 NCCI NCCI Standards of medical / surgical practice 31585 31578 NCCI NCCI Standards of medical / surgical practice 31585 31579 NCCI NCCI Most extensive procedures 31585 31580 NCCI NCCI Mutually exclusive procedures 31585 31582 NCCI NCCI Mutually exclusive procedures 31585 31584 NCCI NCCI Mutually exclusive procedures 31585 31585 BCBST 31585 31587 NCCI NCCI Mutually exclusive procedures 31585 31588 NCCI NCCI Mutually exclusive procedures 31585 31590 NCCI NCCI Mutually exclusive procedures 31585 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 64416 NCCI Misuse of Column 2 code with Column 1 code 31585 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31585 90780 NCCI NCCI Standards of medical / surgical practice 31585 92502 NCCI NCCI Standards of medical / surgical practice 31585 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31586 00320 NCCI Anesthesia included in surgical procedures 31586 00326 NCCI Anesthesia included in surgical procedures 31586 20100 NCCI NCCI HCPCS/CPT separate procedure definition 31586 31505 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 82 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31586 31510 NCCI NCCI Standards of medical / surgical practice 31586 31511 NCCI NCCI Standards of medical / surgical practice 31586 31512 NCCI NCCI Standards of medical / surgical practice 31586 31513 NCCI NCCI Standards of medical / surgical practice 31586 31515 NCCI NCCI Standards of medical / surgical practice 31586 31520 NCCI NCCI Standards of medical / surgical practice 31586 31525 NCCI NCCI Sequential procedures 31586 31526 NCCI NCCI Sequential procedures 31586 31527 NCCI NCCI Standards of medical / surgical practice 31586 31528 NCCI NCCI Standards of medical / surgical practice 31586 31529 NCCI NCCI Standards of medical / surgical practice 31586 31530 NCCI NCCI Standards of medical / surgical practice 31586 31531 NCCI NCCI Standards of medical / surgical practice 31586 31536 NCCI NCCI Standards of medical / surgical practice 31586 31540 NCCI NCCI Standards of medical / surgical practice 31586 31541 NCCI NCCI Standards of medical / surgical practice 31586 31560 NCCI NCCI Standards of medical / surgical practice 31586 31561 NCCI NCCI Standards of medical / surgical practice 31586 31570 NCCI NCCI Standards of medical / surgical practice 31586 31571 NCCI NCCI Standards of medical / surgical practice 31586 31575 NCCI NCCI Sequential procedures 31586 31576 NCCI NCCI Standards of medical / surgical practice 31586 31577 NCCI NCCI Standards of medical / surgical practice 31586 31578 NCCI NCCI Standards of medical / surgical practice 31586 31579 NCCI NCCI Most extensive procedures 31586 31580 NCCI NCCI Mutually exclusive procedures 31586 31582 NCCI NCCI Mutually exclusive procedures 31586 31584 NCCI NCCI Mutually exclusive procedures 31586 31586 BCBST 31586 31587 NCCI NCCI Mutually exclusive procedures 31586 31588 NCCI NCCI Mutually exclusive procedures 31586 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 64416 NCCI Misuse of Column 2 code with Column 1 code 31586 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 83 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31586 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31586 90780 NCCI NCCI Standards of medical / surgical practice 31586 92502 NCCI NCCI Standards of medical / surgical practice 31586 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31587 00320 NCCI Anesthesia included in surgical procedures 31587 00326 NCCI Anesthesia included in surgical procedures 31587 31505 NCCI NCCI Standards of medical / surgical practice 31587 31510 NCCI NCCI Standards of medical / surgical practice 31587 31511 NCCI NCCI Standards of medical / surgical practice 31587 31512 NCCI NCCI Standards of medical / surgical practice 31587 31513 NCCI NCCI Standards of medical / surgical practice 31587 31515 NCCI NCCI Standards of medical / surgical practice 31587 31520 NCCI NCCI Standards of medical / surgical practice 31587 31525 NCCI NCCI Sequential procedures 31587 31526 NCCI NCCI Sequential procedures 31587 31527 NCCI NCCI Standards of medical / surgical practice 31587 31528 NCCI NCCI Standards of medical / surgical practice 31587 31529 NCCI NCCI Standards of medical / surgical practice 31587 31530 NCCI NCCI Standards of medical / surgical practice 31587 31531 NCCI NCCI Standards of medical / surgical practice 31587 31536 NCCI NCCI Standards of medical / surgical practice 31587 31540 NCCI NCCI Standards of medical / surgical practice 31587 31541 NCCI NCCI Standards of medical / surgical practice 31587 31560 NCCI NCCI Standards of medical / surgical practice 31587 31561 NCCI NCCI Standards of medical / surgical practice 31587 31570 NCCI NCCI Standards of medical / surgical practice 31587 31571 NCCI NCCI Standards of medical / surgical practice 31587 31575 NCCI NCCI Sequential procedures 31587 31576 NCCI NCCI Standards of medical / surgical practice 31587 31577 NCCI NCCI Standards of medical / surgical practice 31587 31578 NCCI NCCI Standards of medical / surgical practice 31587 31579 NCCI NCCI Most extensive procedures 31587 31580 NCCI NCCI Mutually exclusive procedures 31587 31582 NCCI NCCI Mutually exclusive procedures 31587 31584 NCCI NCCI Mutually exclusive procedures 31587 31587 BCBST 31587 31588 NCCI CPT TM Procedure redundant to itself. NCCI Mutually exclusive procedures is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 84 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31587 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31587 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 64416 NCCI Misuse of Column 2 code with Column 1 code 31587 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31587 90780 NCCI NCCI Standards of medical / surgical practice 31587 92502 NCCI NCCI Standards of medical / surgical practice 31587 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31588 00320 NCCI Anesthesia included in surgical procedures 31588 00326 NCCI Anesthesia included in surgical procedures 31588 31505 NCCI NCCI Standards of medical / surgical practice 31588 31510 NCCI NCCI Standards of medical / surgical practice 31588 31511 NCCI NCCI Standards of medical / surgical practice 31588 31512 NCCI NCCI Standards of medical / surgical practice 31588 31513 NCCI NCCI Standards of medical / surgical practice 31588 31515 NCCI NCCI Standards of medical / surgical practice 31588 31520 NCCI NCCI Standards of medical / surgical practice 31588 31525 NCCI NCCI Sequential procedures 31588 31526 NCCI NCCI Sequential procedures 31588 31527 NCCI NCCI Standards of medical / surgical practice 31588 31528 NCCI NCCI Standards of medical / surgical practice 31588 31529 NCCI NCCI Standards of medical / surgical practice 31588 31530 NCCI NCCI Standards of medical / surgical practice 31588 31531 NCCI NCCI Standards of medical / surgical practice 31588 31536 NCCI NCCI Standards of medical / surgical practice 31588 31540 NCCI NCCI Standards of medical / surgical practice 31588 31541 NCCI NCCI Standards of medical / surgical practice 31588 31560 NCCI NCCI Standards of medical / surgical practice 31588 31561 NCCI NCCI Standards of medical / surgical practice 31588 31570 NCCI NCCI Standards of medical / surgical practice 31588 31571 NCCI NCCI Standards of medical / surgical practice 31588 31575 NCCI NCCI Sequential procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 85 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31588 31576 NCCI NCCI Standards of medical / surgical practice 31588 31577 NCCI NCCI Standards of medical / surgical practice 31588 31578 NCCI NCCI Standards of medical / surgical practice 31588 31579 NCCI NCCI Most extensive procedures 31588 31582 NCCI NCCI Mutually exclusive procedures 31588 31584 NCCI NCCI Mutually exclusive procedures 31588 31588 BCBST 31588 31590 NCCI NCCI Most extensive procedures 31588 31595 NCCI NCCI HCPCS/CPT separate procedure definition 31588 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31588 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 64416 NCCI Misuse of Column 2 code with Column 1 code 31588 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31588 90780 NCCI NCCI Standards of medical / surgical practice 31588 92502 NCCI NCCI Standards of medical / surgical practice 31588 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31590 00320 NCCI Anesthesia included in surgical procedures 31590 00326 NCCI Anesthesia included in surgical procedures 31590 31505 NCCI NCCI Standards of medical / surgical practice 31590 31510 NCCI NCCI Standards of medical / surgical practice 31590 31511 NCCI NCCI Standards of medical / surgical practice 31590 31512 NCCI NCCI Standards of medical / surgical practice 31590 31513 NCCI NCCI Standards of medical / surgical practice 31590 31515 NCCI NCCI Standards of medical / surgical practice 31590 31520 NCCI NCCI Standards of medical / surgical practice 31590 31527 NCCI NCCI Standards of medical / surgical practice 31590 31528 NCCI NCCI Standards of medical / surgical practice 31590 31529 NCCI NCCI Standards of medical / surgical practice 31590 31530 NCCI NCCI Standards of medical / surgical practice 31590 31531 NCCI NCCI Standards of medical / surgical practice 31590 31536 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 86 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31590 31540 NCCI NCCI Standards of medical / surgical practice 31590 31541 NCCI NCCI Standards of medical / surgical practice 31590 31560 NCCI NCCI Standards of medical / surgical practice 31590 31561 NCCI NCCI Standards of medical / surgical practice 31590 31570 NCCI NCCI Standards of medical / surgical practice 31590 31571 NCCI NCCI Standards of medical / surgical practice 31590 31576 NCCI NCCI Standards of medical / surgical practice 31590 31577 NCCI NCCI Standards of medical / surgical practice 31590 31578 NCCI NCCI Standards of medical / surgical practice 31590 31579 NCCI NCCI Most extensive procedures 31590 31580 NCCI NCCI Mutually exclusive procedures 31590 31582 NCCI NCCI Mutually exclusive procedures 31590 31584 NCCI NCCI Mutually exclusive procedures 31590 31586 NCCI NCCI Mutually exclusive procedures 31590 31587 NCCI NCCI Mutually exclusive procedures 31590 31590 BCBST 31590 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 64416 NCCI Misuse of Column 2 code with Column 1 code 31590 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31590 90780 NCCI NCCI Standards of medical / surgical practice 31590 92502 NCCI NCCI Standards of medical / surgical practice 31590 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31595 00320 NCCI Anesthesia included in surgical procedures 31595 00326 NCCI Anesthesia included in surgical procedures 31595 31505 NCCI NCCI Standards of medical / surgical practice 31595 31510 NCCI NCCI Standards of medical / surgical practice 31595 31511 NCCI NCCI Standards of medical / surgical practice 31595 31512 NCCI NCCI Standards of medical / surgical practice 31595 31513 NCCI NCCI Standards of medical / surgical practice 31595 31515 NCCI NCCI Standards of medical / surgical practice 31595 31520 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 87 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31595 31525 NCCI NCCI Standards of medical / surgical practice 31595 31526 NCCI NCCI Standards of medical / surgical practice 31595 31527 NCCI NCCI Standards of medical / surgical practice 31595 31528 NCCI NCCI Standards of medical / surgical practice 31595 31529 NCCI NCCI Standards of medical / surgical practice 31595 31530 NCCI NCCI Standards of medical / surgical practice 31595 31531 NCCI NCCI Standards of medical / surgical practice 31595 31536 NCCI NCCI Standards of medical / surgical practice 31595 31540 NCCI NCCI Standards of medical / surgical practice 31595 31541 NCCI NCCI Standards of medical / surgical practice 31595 31560 NCCI NCCI Standards of medical / surgical practice 31595 31561 NCCI NCCI Standards of medical / surgical practice 31595 31570 NCCI NCCI Standards of medical / surgical practice 31595 31571 NCCI NCCI Standards of medical / surgical practice 31595 31575 NCCI NCCI Standards of medical / surgical practice 31595 31576 NCCI NCCI Standards of medical / surgical practice 31595 31577 NCCI NCCI Standards of medical / surgical practice 31595 31578 NCCI NCCI Standards of medical / surgical practice 31595 31579 NCCI NCCI Most extensive procedures 31595 31580 NCCI NCCI Mutually exclusive procedures 31595 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 64416 NCCI Misuse of Column 2 code with Column 1 code 31595 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31595 90780 NCCI NCCI Standards of medical / surgical practice 31595 92502 NCCI NCCI Standards of medical / surgical practice 31595 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31599 31599 BCBST 31599 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31600 00320 NCCI Anesthesia included in surgical procedures 31600 00326 NCCI Anesthesia included in surgical procedures 31600 00520 NCCI NCCI Anesthesia included in surgical procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 88 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31600 31600 BCBST Procedure redundant to itself. 31600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 64416 NCCI Misuse of Column 2 code with Column 1 code 31600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 64420 NCCI Misuse of Column 2 code with Column 1 code 31600 64421 NCCI Misuse of Column 2 code with Column 1 code 31600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31600 90780 NCCI NCCI Standards of medical / surgical practice 31600 92502 NCCI NCCI Standards of medical / surgical practice 31600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31601 00320 NCCI Anesthesia included in surgical procedures 31601 00326 NCCI Anesthesia included in surgical procedures 31601 00520 NCCI NCCI Anesthesia included in surgical procedures 31601 31601 BCBST 31601 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 64416 NCCI Misuse of Column 2 code with Column 1 code 31601 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 64420 NCCI Misuse of Column 2 code with Column 1 code 31601 64421 NCCI Misuse of Column 2 code with Column 1 code 31601 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31601 90780 NCCI NCCI Standards of medical / surgical practice 31601 92502 NCCI NCCI Standards of medical / surgical practice 31601 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31603 00320 NCCI Anesthesia included in surgical procedures 31603 00326 NCCI Anesthesia included in surgical procedures 31603 00520 NCCI NCCI Anesthesia included in surgical procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 89 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31603 31320 NCCI NCCI Standards of medical / surgical practice 31603 31525 NCCI NCCI Standards of medical / surgical practice 31603 31526 NCCI NCCI Standards of medical / surgical practice 31603 31575 NCCI NCCI Standards of medical / surgical practice 31603 31603 BCBST 31603 31610 NCCI NCCI Mutually exclusive procedures 31603 31613 NCCI NCCI Mutually exclusive procedures 31603 31614 NCCI NCCI Mutually exclusive procedures 31603 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 64416 NCCI Misuse of Column 2 code with Column 1 code 31603 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 64420 NCCI Misuse of Column 2 code with Column 1 code 31603 64421 NCCI Misuse of Column 2 code with Column 1 code 31603 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31603 90780 NCCI NCCI Standards of medical / surgical practice 31603 92502 NCCI NCCI Standards of medical / surgical practice 31603 D7990 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. 31603 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31605 00320 NCCI Anesthesia included in surgical procedures 31605 00326 NCCI Anesthesia included in surgical procedures 31605 00520 NCCI NCCI Anesthesia included in surgical procedures 31605 31603 NCCI NCCI Mutually exclusive procedures 31605 31605 BCBST 31605 31610 NCCI NCCI Mutually exclusive procedures 31605 31613 NCCI NCCI Mutually exclusive procedures 31605 31614 NCCI NCCI Mutually exclusive procedures 31605 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 64416 NCCI Misuse of Column 2 code with Column 1 code 31605 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 90 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31605 64420 NCCI Misuse of Column 2 code with Column 1 code 31605 64421 NCCI Misuse of Column 2 code with Column 1 code 31605 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31605 90780 NCCI NCCI Standards of medical / surgical practice 31605 92502 NCCI NCCI Standards of medical / surgical practice 31605 D7990 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. 31605 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31610 00320 NCCI Anesthesia included in surgical procedures 31610 00326 NCCI Anesthesia included in surgical procedures 31610 00520 NCCI NCCI Anesthesia included in surgical procedures 31610 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31610 31601 NCCI NCCI HCPCS/CPT separate procedure definition 31610 31610 BCBST 31610 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 64416 NCCI Misuse of Column 2 code with Column 1 code 31610 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 64420 NCCI Misuse of Column 2 code with Column 1 code 31610 64421 NCCI Misuse of Column 2 code with Column 1 code 31610 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31610 90780 NCCI NCCI Standards of medical / surgical practice 31610 92502 NCCI NCCI Standards of medical / surgical practice 31610 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31611 00320 NCCI Anesthesia included in surgical procedures 31611 00326 NCCI Anesthesia included in surgical procedures 31611 00520 NCCI NCCI Anesthesia included in surgical procedures 31611 31525 NCCI NCCI Sequential procedures 31611 31526 NCCI NCCI Sequential procedures 31611 31575 NCCI NCCI Sequential procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 91 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31611 31600 31611 31611 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 31601 NCCI NCCI HCPCS/CPT separate procedure definition 31611 BCBST 31611 31614 NCCI NCCI Mutually exclusive procedures 31611 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 64416 NCCI Misuse of Column 2 code with Column 1 code 31611 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 64420 NCCI Misuse of Column 2 code with Column 1 code 31611 64421 NCCI Misuse of Column 2 code with Column 1 code 31611 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31611 90780 NCCI NCCI Standards of medical / surgical practice 31611 92502 NCCI NCCI Standards of medical / surgical practice 31611 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31612 00320 NCCI Anesthesia included in surgical procedures 31612 00326 NCCI Anesthesia included in surgical procedures 31612 00520 NCCI NCCI Anesthesia included in surgical procedures 31612 31525 NCCI NCCI Sequential procedures 31612 31526 NCCI NCCI Sequential procedures 31612 31575 NCCI NCCI Sequential procedures 31612 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31612 31603 NCCI NCCI Mutually exclusive procedures 31612 31605 NCCI NCCI Mutually exclusive procedures 31612 31610 NCCI NCCI Mutually exclusive procedures 31612 31611 NCCI NCCI Mutually exclusive procedures 31612 31612 BCBST 31612 31613 NCCI NCCI Mutually exclusive procedures 31612 31614 NCCI NCCI Mutually exclusive procedures 31612 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 92 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31612 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 64420 NCCI Misuse of Column 2 code with Column 1 code 31612 64421 NCCI Misuse of Column 2 code with Column 1 code 31612 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31612 90780 NCCI NCCI Standards of medical / surgical practice 31612 92502 NCCI NCCI Standards of medical / surgical practice 31612 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31613 00320 NCCI Anesthesia included in surgical procedures 31613 00326 NCCI Anesthesia included in surgical procedures 31613 00520 NCCI NCCI Anesthesia included in surgical procedures 31613 31525 NCCI NCCI Sequential procedures 31613 31526 NCCI NCCI Sequential procedures 31613 31575 NCCI NCCI Sequential procedures 31613 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31613 31601 NCCI NCCI HCPCS/CPT separate procedure definition 31613 31610 NCCI NCCI Mutually exclusive procedures 31613 31611 NCCI NCCI Mutually exclusive procedures 31613 31613 BCBST 31613 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 64416 NCCI Misuse of Column 2 code with Column 1 code 31613 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 64420 NCCI Misuse of Column 2 code with Column 1 code 31613 64421 NCCI Misuse of Column 2 code with Column 1 code 31613 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31613 90780 NCCI NCCI Standards of medical / surgical practice 31613 92502 NCCI NCCI Standards of medical / surgical practice 31613 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31614 00320 NCCI Anesthesia included in surgical procedures 31614 00326 NCCI Anesthesia included in surgical procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 93 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31614 00520 NCCI NCCI Anesthesia included in surgical procedures 31614 31515 NCCI NCCI Most extensive procedures 31614 31525 NCCI NCCI Sequential procedures 31614 31526 NCCI NCCI Sequential procedures 31614 31575 NCCI NCCI Sequential procedures 31614 31600 NCCI NCCI HCPCS/CPT separate procedure definition 31614 31601 NCCI NCCI HCPCS/CPT separate procedure definition 31614 31610 NCCI NCCI Mutually exclusive procedures 31614 31613 NCCI NCCI "With" versus "without" procedures 31614 31614 BCBST 31614 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 64416 NCCI Misuse of Column 2 code with Column 1 code 31614 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 64420 NCCI Misuse of Column 2 code with Column 1 code 31614 64421 NCCI Misuse of Column 2 code with Column 1 code 31614 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31614 90780 NCCI NCCI Standards of medical / surgical practice 31614 92502 NCCI NCCI Standards of medical / surgical practice 31614 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31615 00320 NCCI Anesthesia included in surgical procedures 31615 00326 NCCI Anesthesia included in surgical procedures 31615 00520 NCCI NCCI Anesthesia included in surgical procedures 31615 31575 NCCI NCCI Sequential procedures 31615 31610 NCCI NCCI Mutually exclusive procedures 31615 31615 BCBST 31615 31717 NCCI NCCI Mutually exclusive procedures 31615 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31615 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31615 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 94 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31615 64416 NCCI Misuse of Column 2 code with Column 1 code 31615 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 64420 NCCI Misuse of Column 2 code with Column 1 code 31615 64421 NCCI Misuse of Column 2 code with Column 1 code 31615 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31615 90780 NCCI NCCI Standards of medical / surgical practice 31615 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31622 00520 NCCI NCCI Anesthesia included in surgical procedures 31622 31525 NCCI NCCI Most extensive procedures 31622 31575 NCCI NCCI Most extensive procedures 31622 31622 BCBST 31622 31717 NCCI NCCI Standards of medical / surgical practice 31622 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31622 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31622 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 64416 NCCI Misuse of Column 2 code with Column 1 code 31622 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 64420 NCCI Misuse of Column 2 code with Column 1 code 31622 64421 NCCI Misuse of Column 2 code with Column 1 code 31622 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31622 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31622 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31622 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31622 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31622 90780 NCCI NCCI Standards of medical / surgical practice 31622 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31622 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31623 00520 NCCI NCCI Anesthesia included in surgical procedures 31623 00528 NCCI NCCI Anesthesia included in surgical procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 95 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31623 31525 NCCI NCCI Most extensive procedures 31623 31526 NCCI NCCI Most extensive procedures 31623 31535 NCCI NCCI Most extensive procedures 31623 31575 NCCI NCCI Most extensive procedures 31623 31622 NCCI NCCI HCPCS/CPT separate procedure definition 31623 31623 BCBST 31623 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31623 31717 NCCI NCCI Standards of medical / surgical practice 31623 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31623 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31623 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 64416 NCCI Misuse of Column 2 code with Column 1 code 31623 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 64420 NCCI Misuse of Column 2 code with Column 1 code 31623 64421 NCCI Misuse of Column 2 code with Column 1 code 31623 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31623 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31623 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31623 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31623 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31623 90780 NCCI NCCI Standards of medical / surgical practice 31623 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31623 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31624 00520 NCCI NCCI Anesthesia included in surgical procedures 31624 00528 NCCI NCCI Anesthesia included in surgical procedures 31624 31525 NCCI NCCI Most extensive procedures 31624 31526 NCCI NCCI Most extensive procedures 31624 31535 NCCI NCCI Most extensive procedures 31624 31575 NCCI NCCI Most extensive procedures 31624 31622 NCCI NCCI HCPCS/CPT separate procedure definition 31624 31624 BCBST CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 96 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31624 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31624 31717 NCCI NCCI Standards of medical / surgical practice 31624 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31624 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31624 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 64416 NCCI Misuse of Column 2 code with Column 1 code 31624 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 64420 NCCI Misuse of Column 2 code with Column 1 code 31624 64421 NCCI Misuse of Column 2 code with Column 1 code 31624 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31624 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31624 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31624 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31624 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31624 90780 NCCI NCCI Standards of medical / surgical practice 31624 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31624 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31625 00520 NCCI NCCI Anesthesia included in surgical procedures 31625 31525 NCCI NCCI Most extensive procedures 31625 31526 NCCI NCCI Most extensive procedures 31625 31535 NCCI NCCI Most extensive procedures 31625 31575 NCCI NCCI Most extensive procedures 31625 31622 NCCI NCCI Standards of medical / surgical practice 31625 31625 BCBST 31625 31717 NCCI NCCI Standards of medical / surgical practice 31625 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31625 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31625 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 97 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31625 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 64420 NCCI Misuse of Column 2 code with Column 1 code 31625 64421 NCCI Misuse of Column 2 code with Column 1 code 31625 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31625 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31625 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31625 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31625 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31625 90780 NCCI NCCI Standards of medical / surgical practice 31625 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31625 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31628 00520 NCCI NCCI Anesthesia included in surgical procedures 31628 31525 NCCI NCCI Most extensive procedures 31628 31526 NCCI NCCI Most extensive procedures 31628 31535 NCCI NCCI Most extensive procedures 31628 31536 NCCI NCCI Most extensive procedures 31628 31575 NCCI NCCI Most extensive procedures 31628 31622 NCCI NCCI Standards of medical / surgical practice 31628 31625 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 31628 BCBST 31628 31717 NCCI NCCI Most extensive procedures 31628 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31628 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31628 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 64416 NCCI Misuse of Column 2 code with Column 1 code 31628 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 64420 NCCI Misuse of Column 2 code with Column 1 code 31628 64421 NCCI Misuse of Column 2 code with Column 1 code 31628 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31628 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 98 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31628 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31628 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31628 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31628 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31628 90780 NCCI NCCI Standards of medical / surgical practice 31628 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31628 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31629 00520 NCCI NCCI Anesthesia included in surgical procedures 31629 31525 NCCI NCCI Most extensive procedures 31629 31526 NCCI NCCI Most extensive procedures 31629 31535 NCCI NCCI Most extensive procedures 31629 31575 NCCI NCCI Most extensive procedures 31629 31622 NCCI NCCI Standards of medical / surgical practice 31629 31625 NCCI NCCI Standards of medical / surgical practice 31629 31629 BCBST 31629 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31629 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 64416 NCCI Misuse of Column 2 code with Column 1 code 31629 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 64420 NCCI Misuse of Column 2 code with Column 1 code 31629 64421 NCCI Misuse of Column 2 code with Column 1 code 31629 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31629 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31629 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31629 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31629 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31629 90780 NCCI NCCI Standards of medical / surgical practice 31629 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31629 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31630 00520 NCCI NCCI Anesthesia included in surgical procedures 31630 31525 NCCI NCCI Most extensive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 99 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31630 31526 NCCI NCCI Most extensive procedures 31630 31535 NCCI NCCI Most extensive procedures 31630 31536 NCCI NCCI Most extensive procedures 31630 31540 NCCI NCCI Most extensive procedures 31630 31575 NCCI NCCI Most extensive procedures 31630 31622 NCCI NCCI Standards of medical / surgical practice 31630 31630 BCBST 31630 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31630 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31630 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 64416 NCCI Misuse of Column 2 code with Column 1 code 31630 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 64420 NCCI Misuse of Column 2 code with Column 1 code 31630 64421 NCCI Misuse of Column 2 code with Column 1 code 31630 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31630 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31630 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31630 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31630 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31630 90780 NCCI NCCI Standards of medical / surgical practice 31630 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31630 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31631 00520 NCCI NCCI Anesthesia included in surgical procedures 31631 31525 NCCI NCCI Most extensive procedures 31631 31526 NCCI NCCI Most extensive procedures 31631 31535 NCCI NCCI Most extensive procedures 31631 31536 NCCI NCCI Most extensive procedures 31631 31540 NCCI NCCI Most extensive procedures 31631 31575 NCCI NCCI Most extensive procedures 31631 31622 NCCI NCCI Standards of medical / surgical practice 31631 31630 NCCI NCCI HCPCS/CPT procedure code definition CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 100 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31631 31631 BCBST Procedure redundant to itself. 31631 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31631 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31631 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 64416 NCCI Misuse of Column 2 code with Column 1 code 31631 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 64420 NCCI Misuse of Column 2 code with Column 1 code 31631 64421 NCCI Misuse of Column 2 code with Column 1 code 31631 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31631 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31631 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31631 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31631 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31631 90780 NCCI NCCI Standards of medical / surgical practice 31631 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31631 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31635 00520 NCCI NCCI Anesthesia included in surgical procedures 31635 31525 NCCI NCCI Most extensive procedures 31635 31526 NCCI NCCI Most extensive procedures 31635 31535 NCCI NCCI Most extensive procedures 31635 31536 NCCI NCCI Most extensive procedures 31635 31540 NCCI NCCI Most extensive procedures 31635 31575 NCCI NCCI Most extensive procedures 31635 31622 NCCI NCCI Standards of medical / surgical practice 31635 31635 BCBST 31635 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31635 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31635 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 101 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31635 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 64416 NCCI Misuse of Column 2 code with Column 1 code 31635 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 64420 NCCI Misuse of Column 2 code with Column 1 code 31635 64421 NCCI Misuse of Column 2 code with Column 1 code 31635 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31635 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31635 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31635 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31635 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31635 90780 NCCI NCCI Standards of medical / surgical practice 31635 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31635 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31640 00520 NCCI NCCI Anesthesia included in surgical procedures 31640 31525 NCCI NCCI Most extensive procedures 31640 31526 NCCI NCCI Most extensive procedures 31640 31535 NCCI NCCI Most extensive procedures 31640 31536 NCCI NCCI Most extensive procedures 31640 31540 NCCI NCCI Most extensive procedures 31640 31541 NCCI NCCI Most extensive procedures 31640 31575 NCCI NCCI Most extensive procedures 31640 31622 NCCI NCCI Standards of medical / surgical practice 31640 31625 NCCI NCCI Most extensive procedures 31640 31640 BCBST 31640 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31640 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31640 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 64416 NCCI Misuse of Column 2 code with Column 1 code 31640 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 64420 NCCI Misuse of Column 2 code with Column 1 code 31640 64421 NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 102 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31640 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31640 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31640 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31640 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31640 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31640 90780 NCCI NCCI Standards of medical / surgical practice 31640 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31640 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31641 00520 NCCI NCCI Anesthesia included in surgical procedures 31641 31525 NCCI NCCI Most extensive procedures 31641 31526 NCCI NCCI Most extensive procedures 31641 31535 NCCI NCCI Most extensive procedures 31641 31536 NCCI NCCI Most extensive procedures 31641 31540 NCCI NCCI Most extensive procedures 31641 31541 NCCI NCCI Most extensive procedures 31641 31575 NCCI NCCI Most extensive procedures 31641 31622 NCCI NCCI Standards of medical / surgical practice 31641 31625 NCCI NCCI Most extensive procedures 31641 31640 BCBST NCCI Refer to Specific Guidelines 31641 31641 BCBST Procedure redundant to itself. 31641 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31641 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 64416 NCCI Misuse of Column 2 code with Column 1 code 31641 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 64420 NCCI Misuse of Column 2 code with Column 1 code 31641 64421 NCCI Misuse of Column 2 code with Column 1 code 31641 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31641 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 103 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31641 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31641 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31641 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31641 90780 NCCI NCCI Standards of medical / surgical practice 31641 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31641 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31643 00520 NCCI NCCI Anesthesia included in surgical procedures 31643 00528 NCCI NCCI Anesthesia included in surgical procedures 31643 31525 NCCI NCCI Most extensive procedures 31643 31526 NCCI NCCI Most extensive procedures 31643 31535 NCCI NCCI Most extensive procedures 31643 31575 NCCI NCCI Most extensive procedures 31643 31622 NCCI NCCI HCPCS/CPT separate procedure definition 31643 31643 BCBST 31643 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31643 31717 NCCI NCCI Standards of medical / surgical practice 31643 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31643 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31643 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 64416 NCCI Misuse of Column 2 code with Column 1 code 31643 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 64420 NCCI Misuse of Column 2 code with Column 1 code 31643 64421 NCCI Misuse of Column 2 code with Column 1 code 31643 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31643 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31643 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31643 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31643 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31643 90780 NCCI NCCI Standards of medical / surgical practice 31643 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31643 S0020 CPT CMS 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 TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 104 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31645 00520 NCCI NCCI Anesthesia included in surgical procedures 31645 31525 NCCI NCCI Most extensive procedures 31645 31526 NCCI NCCI Most extensive procedures 31645 31575 NCCI NCCI Most extensive procedures 31645 31622 NCCI NCCI Standards of medical / surgical practice 31645 31645 BCBST 31645 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31645 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31645 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 64416 NCCI Misuse of Column 2 code with Column 1 code 31645 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 64420 NCCI Misuse of Column 2 code with Column 1 code 31645 64421 NCCI Misuse of Column 2 code with Column 1 code 31645 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31645 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31645 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31645 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31645 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31645 90780 NCCI NCCI Standards of medical / surgical practice 31645 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31645 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31646 00520 NCCI NCCI Anesthesia included in surgical procedures 31646 31525 NCCI NCCI Most extensive procedures 31646 31526 NCCI NCCI Most extensive procedures 31646 31575 NCCI NCCI Most extensive procedures 31646 31622 NCCI NCCI Standards of medical / surgical practice 31646 31646 BCBST 31646 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31646 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31646 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 105 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31646 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 64416 NCCI Misuse of Column 2 code with Column 1 code 31646 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 64420 NCCI Misuse of Column 2 code with Column 1 code 31646 64421 NCCI Misuse of Column 2 code with Column 1 code 31646 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31646 76000 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31646 76001 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31646 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31646 76003 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 31646 90780 NCCI NCCI Standards of medical / surgical practice 31646 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31646 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31656 00520 NCCI NCCI Anesthesia included in surgical procedures 31656 31525 NCCI NCCI Most extensive procedures 31656 31575 NCCI NCCI Most extensive procedures 31656 31622 NCCI NCCI Standards of medical / surgical practice 31656 31656 BCBST 31656 31708 NCCI NCCI Most extensive procedures 31656 31717 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 31720 NCCI NCCI HCPCS/CPT separate procedure definition 31656 31725 NCCI NCCI HCPCS/CPT separate procedure definition 31656 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 64416 NCCI Misuse of Column 2 code with Column 1 code 31656 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 64420 NCCI Misuse of Column 2 code with Column 1 code 31656 64421 NCCI Misuse of Column 2 code with Column 1 code 31656 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 106 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31656 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31656 90780 NCCI NCCI Standards of medical / surgical practice 31656 92511 NCCI NCCI HCPCS/CPT separate procedure definition 31656 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31700 00520 NCCI NCCI Anesthesia included in surgical procedures 31700 31700 BCBST 31700 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 64416 NCCI Misuse of Column 2 code with Column 1 code 31700 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 64420 NCCI Misuse of Column 2 code with Column 1 code 31700 64421 NCCI Misuse of Column 2 code with Column 1 code 31700 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31700 90780 NCCI NCCI Standards of medical / surgical practice 31700 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31708 00520 NCCI NCCI Anesthesia included in surgical procedures 31708 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31708 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 64416 NCCI Misuse of Column 2 code with Column 1 code 31708 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 64420 NCCI Misuse of Column 2 code with Column 1 code 31708 64421 NCCI Misuse of Column 2 code with Column 1 code 31708 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31708 90780 NCCI NCCI Standards of medical / surgical practice 31708 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31710 00520 NCCI NCCI Anesthesia included in surgical procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 107 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31710 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31710 31708 NCCI NCCI Mutually exclusive procedures 31710 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 64416 NCCI Misuse of Column 2 code with Column 1 code 31710 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 64420 NCCI Misuse of Column 2 code with Column 1 code 31710 64421 NCCI Misuse of Column 2 code with Column 1 code 31710 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31710 90780 NCCI NCCI Standards of medical / surgical practice 31710 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31715 00520 NCCI NCCI Anesthesia included in surgical procedures 31715 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31715 31708 NCCI NCCI Mutually exclusive procedures 31715 31710 NCCI NCCI Mutually exclusive procedures 31715 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 64416 NCCI Misuse of Column 2 code with Column 1 code 31715 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 64420 NCCI Misuse of Column 2 code with Column 1 code 31715 64421 NCCI Misuse of Column 2 code with Column 1 code 31715 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31715 90780 NCCI NCCI Standards of medical / surgical practice 31715 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31717 00520 NCCI NCCI Anesthesia included in surgical procedures 31717 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31717 31717 BCBST 31717 37202 NCCI CPT TM Procedure redundant to itself. NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 108 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31717 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 64416 NCCI Misuse of Column 2 code with Column 1 code 31717 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 64420 NCCI Misuse of Column 2 code with Column 1 code 31717 64421 NCCI Misuse of Column 2 code with Column 1 code 31717 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31717 90780 NCCI NCCI Standards of medical / surgical practice 31717 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31720 00520 NCCI NCCI Anesthesia included in surgical procedures 31720 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31720 31720 BCBST 31720 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 64416 NCCI Misuse of Column 2 code with Column 1 code 31720 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 64420 NCCI Misuse of Column 2 code with Column 1 code 31720 64421 NCCI Misuse of Column 2 code with Column 1 code 31720 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31720 90780 NCCI NCCI Standards of medical / surgical practice 31720 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31725 00520 NCCI NCCI Anesthesia included in surgical procedures 31725 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31725 31725 BCBST 31725 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 109 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31725 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 64420 NCCI Misuse of Column 2 code with Column 1 code 31725 64421 NCCI Misuse of Column 2 code with Column 1 code 31725 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31725 90780 NCCI NCCI Standards of medical / surgical practice 31725 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31730 00520 NCCI NCCI Anesthesia included in surgical procedures 31730 31700 NCCI NCCI HCPCS/CPT separate procedure definition 31730 31730 BCBST 31730 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 64416 NCCI Misuse of Column 2 code with Column 1 code 31730 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 64420 NCCI Misuse of Column 2 code with Column 1 code 31730 64421 NCCI Misuse of Column 2 code with Column 1 code 31730 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31730 90780 NCCI NCCI Standards of medical / surgical practice 31730 92502 NCCI NCCI Standards of medical / surgical practice 31730 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31750 00520 NCCI NCCI Anesthesia included in surgical procedures 31750 31750 BCBST 31750 31800 NCCI NCCI Standards of medical / surgical practice 31750 31820 NCCI NCCI Standards of medical / surgical practice 31750 31825 NCCI NCCI Standards of medical / surgical practice 31750 31830 NCCI NCCI Standards of medical / surgical practice 31750 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 110 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31750 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31750 90780 NCCI NCCI Standards of medical / surgical practice 31750 92502 NCCI NCCI Standards of medical / surgical practice 31750 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31755 00520 NCCI NCCI Anesthesia included in surgical procedures 31755 31755 BCBST 31755 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 64416 NCCI Misuse of Column 2 code with Column 1 code 31755 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31755 90780 NCCI NCCI Standards of medical / surgical practice 31755 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31760 00520 NCCI NCCI Anesthesia included in surgical procedures 31760 31760 BCBST 31760 31805 NCCI NCCI Standards of medical / surgical practice 31760 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 64416 NCCI Misuse of Column 2 code with Column 1 code 31760 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31760 90780 NCCI NCCI Standards of medical / surgical practice 31760 S0020 CPT CMS 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 TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 111 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31766 00520 NCCI 31766 31766 BCBST 31766 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 64416 NCCI Misuse of Column 2 code with Column 1 code 31766 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31766 90780 NCCI NCCI Standards of medical / surgical practice 31766 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31770 00520 NCCI NCCI Anesthesia included in surgical procedures 31770 31770 BCBST 31770 31775 NCCI NCCI Mutually exclusive procedures 31770 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 64416 NCCI Misuse of Column 2 code with Column 1 code 31770 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31770 90780 NCCI NCCI Standards of medical / surgical practice 31770 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31775 00520 NCCI NCCI Anesthesia included in surgical procedures 31775 31775 BCBST 31775 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 64416 NCCI Misuse of Column 2 code with Column 1 code 31775 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Anesthesia included in surgical procedures Procedure redundant to itself. Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 112 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31775 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31775 90780 NCCI NCCI Standards of medical / surgical practice 31775 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31780 00520 NCCI NCCI Anesthesia included in surgical procedures 31780 31780 BCBST 31780 31781 NCCI NCCI Mutually exclusive procedures 31780 31800 NCCI NCCI Standards of medical / surgical practice 31780 31820 NCCI NCCI Standards of medical / surgical practice 31780 31825 NCCI NCCI Standards of medical / surgical practice 31780 31830 NCCI NCCI Standards of medical / surgical practice 31780 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 64416 NCCI Misuse of Column 2 code with Column 1 code 31780 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31780 90780 NCCI NCCI Standards of medical / surgical practice 31780 92502 NCCI NCCI Standards of medical / surgical practice 31780 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31781 00520 NCCI NCCI Anesthesia included in surgical procedures 31781 31781 BCBST 31781 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 64416 NCCI Misuse of Column 2 code with Column 1 code 31781 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31781 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 113 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 31781 S0020 31785 31785 Source Rationale CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 00520 NCCI NCCI Anesthesia included in surgical procedures 31785 BCBST 31785 31820 NCCI NCCI Standards of medical / surgical practice 31785 31825 NCCI NCCI Standards of medical / surgical practice 31785 31830 NCCI NCCI Standards of medical / surgical practice 31785 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 64416 NCCI Misuse of Column 2 code with Column 1 code 31785 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31785 90780 NCCI NCCI Standards of medical / surgical practice 31785 92502 NCCI NCCI Standards of medical / surgical practice 31785 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31786 00520 NCCI NCCI Anesthesia included in surgical procedures 31786 31786 BCBST 31786 31805 NCCI NCCI Standards of medical / surgical practice 31786 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 64416 NCCI Misuse of Column 2 code with Column 1 code 31786 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31786 90780 NCCI NCCI Standards of medical / surgical practice 31786 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31800 00520 NCCI NCCI Anesthesia included in surgical procedures 31800 31800 BCBST 31800 37202 NCCI CPT TM Procedure redundant to itself. Procedure redundant to itself. Procedure redundant to itself. NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 114 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 64416 NCCI Misuse of Column 2 code with Column 1 code 31800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31800 90780 NCCI NCCI Standards of medical / surgical practice 31800 92502 NCCI NCCI Standards of medical / surgical practice 31800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31805 00520 NCCI NCCI Anesthesia included in surgical procedures 31805 31805 BCBST 31805 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 64416 NCCI Misuse of Column 2 code with Column 1 code 31805 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31805 90780 NCCI NCCI Standards of medical / surgical practice 31805 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31820 00520 NCCI NCCI Anesthesia included in surgical procedures 31820 31820 BCBST 31820 31830 NCCI NCCI Mutually exclusive procedures 31820 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 64416 NCCI Misuse of Column 2 code with Column 1 code 31820 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 115 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31820 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31820 90780 NCCI NCCI Standards of medical / surgical practice 31820 92502 NCCI NCCI Standards of medical / surgical practice 31820 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31825 00520 NCCI NCCI Anesthesia included in surgical procedures 31825 31820 NCCI NCCI "With" versus "without" procedures 31825 31825 BCBST 31825 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 64416 NCCI Misuse of Column 2 code with Column 1 code 31825 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31825 90780 NCCI NCCI Standards of medical / surgical practice 31825 92502 NCCI NCCI Standards of medical / surgical practice 31825 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31830 00520 NCCI NCCI Anesthesia included in surgical procedures 31830 31825 NCCI NCCI Mutually exclusive procedures 31830 31830 BCBST 31830 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 64416 NCCI Misuse of Column 2 code with Column 1 code 31830 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 31830 90780 NCCI NCCI Standards of medical / surgical practice 31830 92502 NCCI NCCI Standards of medical / surgical practice 31830 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 31899 31899 BCBST CPT TM Procedure redundant to itself. Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 116 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 31899 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32000 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32000 32400 NCCI NCCI Standards of medical / surgical practice 32000 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 49423 NCCI NCCI HCPCS/CPT separate procedure definition 32000 49424 NCCI NCCI HCPCS/CPT separate procedure definition 32000 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 64416 NCCI Misuse of Column 2 code with Column 1 code 32000 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32000 90780 NCCI NCCI Standards of medical / surgical practice 32000 99261 BCBST 32000 99262 BCBST 32000 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32002 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32002 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 49424 NCCI NCCI HCPCS/CPT separate procedure definition 32002 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 64416 NCCI Misuse of Column 2 code with Column 1 code 32002 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32002 90780 NCCI NCCI Standards of medical / surgical practice 32002 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32005 32000 NCCI NCCI Standards of medical / surgical practice 32005 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32005 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM HCPCS/CPT coding manual instruction/guideline HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 117 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32005 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 64416 NCCI Misuse of Column 2 code with Column 1 code 32005 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32005 90780 NCCI NCCI Standards of medical / surgical practice 32005 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32020 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 49423 NCCI NCCI HCPCS/CPT separate procedure definition 32020 49424 NCCI NCCI HCPCS/CPT separate procedure definition 32020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 64416 NCCI Misuse of Column 2 code with Column 1 code 32020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32020 90780 NCCI NCCI Standards of medical / surgical practice 32020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32035 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32035 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32035 32036 NCCI NCCI Mutually exclusive procedures 32035 32095 NCCI NCCI Standards of medical / surgical practice 32035 32220 NCCI NCCI HCPCS/CPT separate procedure definition 32035 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32035 32900 NCCI NCCI HCPCS/CPT procedure code definition 32035 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 64416 NCCI Misuse of Column 2 code with Column 1 code 32035 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 118 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32035 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32035 90780 NCCI NCCI Standards of medical / surgical practice 32035 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32036 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32036 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32036 32095 NCCI NCCI Standards of medical / surgical practice 32036 32220 NCCI NCCI HCPCS/CPT separate procedure definition 32036 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32036 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 64416 NCCI Misuse of Column 2 code with Column 1 code 32036 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32036 90780 NCCI NCCI Standards of medical / surgical practice 32036 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32095 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32095 31622 NCCI NCCI Sequential procedures 32095 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32095 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32095 32420 NCCI NCCI Standards of medical / surgical practice 32095 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 64416 NCCI Misuse of Column 2 code with Column 1 code 32095 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32095 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 119 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32095 90780 NCCI NCCI Standards of medical / surgical practice 32095 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32100 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32100 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32100 31622 NCCI NCCI Sequential procedures 32100 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32100 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32100 32095 NCCI NCCI Most extensive procedures 32100 32200 NCCI NCCI Most extensive procedures 32100 32215 NCCI NCCI Standards of medical / surgical practice 32100 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32100 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 64416 NCCI Misuse of Column 2 code with Column 1 code 32100 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32100 90780 NCCI NCCI Standards of medical / surgical practice 32100 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32110 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32110 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32110 31622 NCCI NCCI Standards of medical / surgical practice 32110 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32110 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32110 32095 NCCI NCCI Most extensive procedures 32110 32100 NCCI NCCI Standards of medical / surgical practice 32110 32200 NCCI NCCI Most extensive procedures 32110 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32110 32420 NCCI NCCI Standards of medical / surgical practice 32110 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 120 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32110 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32110 90780 NCCI NCCI Standards of medical / surgical practice 32110 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32120 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32120 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32120 31622 NCCI NCCI Standards of medical / surgical practice 32120 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32120 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32120 32095 NCCI NCCI Standards of medical / surgical practice 32120 32100 NCCI NCCI Standards of medical / surgical practice 32120 32110 NCCI NCCI Mutually exclusive procedures 32120 32215 NCCI NCCI Mutually exclusive procedures 32120 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32120 32420 NCCI NCCI Standards of medical / surgical practice 32120 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 64416 NCCI Misuse of Column 2 code with Column 1 code 32120 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32120 90780 NCCI NCCI Standards of medical / surgical practice 32120 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32124 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32124 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32124 31622 NCCI NCCI Standards of medical / surgical practice 32124 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32124 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32124 32095 NCCI NCCI Standards of medical / surgical practice 32124 32100 NCCI NCCI Standards of medical / surgical practice 32124 32200 NCCI NCCI Most extensive procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 121 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32124 32215 NCCI NCCI Standards of medical / surgical practice 32124 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32124 32420 NCCI NCCI Standards of medical / surgical practice 32124 32654 NCCI NCCI Most extensive procedures 32124 32940 NCCI NCCI Mutually exclusive procedures 32124 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 64416 NCCI Misuse of Column 2 code with Column 1 code 32124 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32124 90780 NCCI NCCI Standards of medical / surgical practice 32124 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32140 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32140 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32140 31622 NCCI NCCI Sequential procedures 32140 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32140 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32140 32095 NCCI NCCI Standards of medical / surgical practice 32140 32100 NCCI NCCI Standards of medical / surgical practice 32140 32200 NCCI NCCI Most extensive procedures 32140 32215 NCCI NCCI Standards of medical / surgical practice 32140 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32140 32420 NCCI NCCI Standards of medical / surgical practice 32140 32654 NCCI NCCI Most extensive procedures 32140 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 64416 NCCI Misuse of Column 2 code with Column 1 code 32140 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32140 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 122 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32140 Source Rationale 69990 NCCI 32140 90780 NCCI NCCI Standards of medical / surgical practice 32140 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32141 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32141 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32141 31622 NCCI NCCI Sequential procedures 32141 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32141 32005 NCCI NCCI Standards of medical / surgical practice 32141 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32141 32095 NCCI NCCI Standards of medical / surgical practice 32141 32100 NCCI NCCI Standards of medical / surgical practice 32141 32200 NCCI NCCI Most extensive procedures 32141 32215 NCCI NCCI Standards of medical / surgical practice 32141 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32141 32420 NCCI NCCI Standards of medical / surgical practice 32141 32654 NCCI NCCI Most extensive procedures 32141 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 64416 NCCI Misuse of Column 2 code with Column 1 code 32141 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32141 90780 NCCI NCCI Standards of medical / surgical practice 32141 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32150 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32150 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32150 31622 NCCI NCCI Sequential procedures 32150 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32150 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32150 32095 NCCI NCCI Standards of medical / surgical practice 32150 32100 NCCI NCCI Standards of medical / surgical practice 32150 32200 NCCI NCCI Most extensive procedures 32150 32215 NCCI NCCI Standards of medical / surgical practice 32150 32225 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 123 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32150 32420 NCCI NCCI Standards of medical / surgical practice 32150 32540 NCCI NCCI Mutually exclusive procedures 32150 32654 NCCI NCCI Most extensive procedures 32150 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 64416 NCCI Misuse of Column 2 code with Column 1 code 32150 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32150 90780 NCCI NCCI Standards of medical / surgical practice 32150 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32151 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32151 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32151 31622 NCCI NCCI Standards of medical / surgical practice 32151 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32151 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32151 32095 NCCI NCCI Standards of medical / surgical practice 32151 32100 NCCI NCCI Standards of medical / surgical practice 32151 32200 NCCI NCCI Most extensive procedures 32151 32215 NCCI NCCI Standards of medical / surgical practice 32151 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32151 32420 NCCI NCCI Standards of medical / surgical practice 32151 32654 NCCI NCCI Most extensive procedures 32151 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 64416 NCCI Misuse of Column 2 code with Column 1 code 32151 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32151 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 124 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32151 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32160 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32160 31595 NCCI NCCI HCPCS/CPT separate procedure definition 32160 31622 NCCI NCCI Standards of medical / surgical practice 32160 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32160 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32160 32095 NCCI NCCI Standards of medical / surgical practice 32160 32100 NCCI NCCI Standards of medical / surgical practice 32160 32160 BCBST 32160 32215 NCCI NCCI Standards of medical / surgical practice 32160 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32160 32420 NCCI NCCI Standards of medical / surgical practice 32160 32654 NCCI NCCI Most extensive procedures 32160 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 64416 NCCI Misuse of Column 2 code with Column 1 code 32160 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32160 90780 NCCI NCCI Standards of medical / surgical practice 32160 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32200 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32200 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32200 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32200 32035 NCCI NCCI Most extensive procedures 32200 32036 NCCI NCCI Most extensive procedures 32200 32420 NCCI NCCI Standards of medical / surgical practice 32200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 64416 NCCI Misuse of Column 2 code with Column 1 code 32200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 125 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32200 90780 NCCI NCCI Standards of medical / surgical practice 32200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32201 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32201 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32201 32201 BCBST 32201 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 64416 NCCI Misuse of Column 2 code with Column 1 code 32201 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32201 90780 NCCI NCCI Standards of medical / surgical practice 32201 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32215 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32215 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32215 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32215 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 64416 NCCI Misuse of Column 2 code with Column 1 code 32215 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32215 90780 NCCI NCCI Standards of medical / surgical practice 32215 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32220 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32220 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 126 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32220 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32220 32310 NCCI NCCI HCPCS/CPT separate procedure definition 32220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 64416 NCCI Misuse of Column 2 code with Column 1 code 32220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32220 90780 NCCI NCCI Standards of medical / surgical practice 32220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32225 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32225 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32225 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 64416 NCCI Misuse of Column 2 code with Column 1 code 32225 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32225 90780 NCCI NCCI Standards of medical / surgical practice 32225 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32310 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32310 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32310 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32310 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32310 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 64416 NCCI Misuse of Column 2 code with Column 1 code 32310 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 127 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32310 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32310 90780 NCCI NCCI Standards of medical / surgical practice 32310 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32320 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32320 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32320 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32320 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32320 32310 NCCI NCCI HCPCS/CPT separate procedure definition 32320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 64416 NCCI Misuse of Column 2 code with Column 1 code 32320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32320 90780 NCCI NCCI Standards of medical / surgical practice 32320 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32400 10021 NCCI NCCI Sequential procedures 32400 10022 NCCI NCCI Sequential procedures 32400 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32400 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32400 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 64416 NCCI Misuse of Column 2 code with Column 1 code 32400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 128 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32400 88172 32400 32400 Source Rationale NCCI NCCI Sequential procedures 90780 NCCI NCCI Standards of medical / surgical practice 99261 BCBST 32400 99262 BCBST 32400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32402 10021 NCCI NCCI Sequential procedures 32402 10022 NCCI NCCI Sequential procedures 32402 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32402 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32402 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32402 32400 NCCI NCCI Sequential procedures 32402 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 64416 NCCI Misuse of Column 2 code with Column 1 code 32402 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32402 88172 NCCI NCCI Sequential procedures 32402 90780 NCCI NCCI Standards of medical / surgical practice 32402 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32405 10021 NCCI NCCI Sequential procedures 32405 10022 NCCI NCCI Sequential procedures 32405 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32405 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32405 32420 NCCI NCCI Standards of medical / surgical practice 32405 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 64416 NCCI Misuse of Column 2 code with Column 1 code 32405 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM HCPCS/CPT coding manual instruction/guideline HCPCS/CPT coding manual instruction/guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 129 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32405 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32405 88172 NCCI NCCI Sequential procedures 32405 90780 NCCI NCCI Standards of medical / surgical practice 32405 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32420 10021 NCCI NCCI Sequential procedures 32420 10022 NCCI NCCI Sequential procedures 32420 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32420 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 64416 NCCI Misuse of Column 2 code with Column 1 code 32420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32420 88172 NCCI NCCI Sequential procedures 32420 90780 NCCI NCCI Standards of medical / surgical practice 32420 99261 BCBST HCPCS/CPT coding manual instruction/guideline 32420 99262 BCBST HCPCS/CPT coding manual instruction/guideline 32420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32440 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32440 31622 NCCI NCCI Sequential procedures 32440 31623 NCCI NCCI Most extensive procedures 32440 31624 NCCI NCCI Most extensive procedures 32440 31625 NCCI NCCI Sequential procedures 32440 31643 NCCI NCCI Most extensive procedures 32440 31645 NCCI NCCI Standards of medical / surgical practice 32440 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32440 32095 NCCI NCCI Most extensive procedures 32440 32100 NCCI NCCI Standards of medical / surgical practice 32440 32140 NCCI NCCI Most extensive procedures 32440 32215 NCCI NCCI Standards of medical / surgical practice 32440 32402 NCCI NCCI Most extensive procedures 32440 32440 BCBST CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 130 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32440 32480 NCCI NCCI HCPCS/CPT procedure code definition 32440 32482 NCCI NCCI HCPCS/CPT procedure code definition 32440 32484 NCCI NCCI HCPCS/CPT procedure code definition 32440 32486 NCCI NCCI Mutually exclusive procedures 32440 32488 NCCI NCCI Mutually exclusive procedures 32440 32491 NCCI NCCI Mutually exclusive procedures 32440 32500 NCCI NCCI HCPCS/CPT procedure code definition 32440 32810 NCCI NCCI Standards of medical / surgical practice 32440 32815 NCCI NCCI Standards of medical / surgical practice 32440 32997 NCCI NCCI Most extensive procedures 32440 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 39010 NCCI NCCI Most extensive procedures 32440 39220 NCCI NCCI Most extensive procedures 32440 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64416 NCCI Misuse of Column 2 code with Column 1 code 32440 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64420 NCCI NCCI Anesthesia included in surgical procedures 32440 64421 NCCI NCCI Anesthesia included in surgical procedures 32440 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 64620 NCCI NCCI Standards of medical / surgical practice 32440 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32440 90780 NCCI NCCI Standards of medical / surgical practice 32440 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32442 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32442 31622 NCCI NCCI Standards of medical / surgical practice 32442 31623 NCCI NCCI Most extensive procedures 32442 31624 NCCI NCCI Most extensive procedures 32442 31625 NCCI NCCI Standards of medical / surgical practice 32442 31643 NCCI NCCI Most extensive procedures 32442 31645 NCCI NCCI Standards of medical / surgical practice 32442 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32442 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32442 32095 NCCI NCCI Most extensive procedures 32442 32100 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 131 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32442 32140 NCCI NCCI Most extensive procedures 32442 32215 NCCI NCCI Standards of medical / surgical practice 32442 32402 NCCI NCCI Most extensive procedures 32442 32440 NCCI NCCI HCPCS/CPT procedure code definition 32442 32442 BCBST 32442 32480 NCCI NCCI HCPCS/CPT procedure code definition 32442 32482 NCCI NCCI HCPCS/CPT procedure code definition 32442 32484 NCCI NCCI HCPCS/CPT procedure code definition 32442 32500 NCCI NCCI HCPCS/CPT procedure code definition 32442 32810 NCCI NCCI Standards of medical / surgical practice 32442 32997 NCCI NCCI Most extensive procedures 32442 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 39010 NCCI NCCI Most extensive procedures 32442 39220 NCCI NCCI Most extensive procedures 32442 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64416 NCCI Misuse of Column 2 code with Column 1 code 32442 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64420 NCCI NCCI Anesthesia included in surgical procedures 32442 64421 NCCI NCCI Anesthesia included in surgical procedures 32442 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 64620 NCCI NCCI Standards of medical / surgical practice 32442 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32442 90780 NCCI NCCI Standards of medical / surgical practice 32442 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32445 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32445 31622 NCCI NCCI Standards of medical / surgical practice 32445 31623 NCCI NCCI Most extensive procedures 32445 31624 NCCI NCCI Most extensive procedures 32445 31625 NCCI NCCI Standards of medical / surgical practice 32445 31643 NCCI NCCI Most extensive procedures 32445 31645 NCCI NCCI Standards of medical / surgical practice 32445 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32445 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32445 32095 NCCI NCCI Most extensive procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 132 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32445 32100 NCCI NCCI Standards of medical / surgical practice 32445 32140 NCCI NCCI Most extensive procedures 32445 32215 NCCI NCCI Standards of medical / surgical practice 32445 32402 NCCI NCCI Most extensive procedures 32445 32440 NCCI NCCI HCPCS/CPT procedure code definition 32445 32445 BCBST 32445 32480 NCCI NCCI HCPCS/CPT procedure code definition 32445 32482 NCCI NCCI HCPCS/CPT procedure code definition 32445 32484 NCCI NCCI HCPCS/CPT procedure code definition 32445 32488 NCCI NCCI Mutually exclusive procedures 32445 32500 NCCI NCCI HCPCS/CPT procedure code definition 32445 32810 NCCI NCCI Standards of medical / surgical practice 32445 32815 NCCI NCCI Standards of medical / surgical practice 32445 32997 NCCI NCCI Most extensive procedures 32445 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 39010 NCCI NCCI Most extensive procedures 32445 39220 NCCI NCCI Most extensive procedures 32445 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64416 NCCI Misuse of Column 2 code with Column 1 code 32445 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64420 NCCI NCCI Anesthesia included in surgical procedures 32445 64421 NCCI NCCI Anesthesia included in surgical procedures 32445 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 64620 NCCI NCCI Standards of medical / surgical practice 32445 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32445 90780 NCCI NCCI Standards of medical / surgical practice 32445 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32480 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32480 31622 NCCI NCCI Standards of medical / surgical practice 32480 31623 NCCI NCCI Most extensive procedures 32480 31624 NCCI NCCI Most extensive procedures 32480 31625 NCCI NCCI Standards of medical / surgical practice 32480 31643 NCCI NCCI Most extensive procedures 32480 31645 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 133 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32480 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32480 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32480 32095 NCCI NCCI Most extensive procedures 32480 32100 NCCI NCCI Standards of medical / surgical practice 32480 32140 NCCI NCCI Most extensive procedures 32480 32215 NCCI NCCI Standards of medical / surgical practice 32480 32402 NCCI NCCI Most extensive procedures 32480 32480 BCBST 32480 32484 NCCI NCCI Mutually exclusive procedures 32480 32520 NCCI NCCI Mutually exclusive procedures 32480 32810 NCCI NCCI Standards of medical / surgical practice 32480 32815 NCCI NCCI Standards of medical / surgical practice 32480 32997 NCCI NCCI Most extensive procedures 32480 35820 NCCI NCCI Standards of medical / surgical practice 32480 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 39010 NCCI NCCI Most extensive procedures 32480 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64416 NCCI Misuse of Column 2 code with Column 1 code 32480 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64420 NCCI NCCI Anesthesia included in surgical procedures 32480 64421 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 64620 NCCI NCCI Standards of medical / surgical practice 32480 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32480 90780 NCCI NCCI Standards of medical / surgical practice 32480 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32482 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32482 31622 NCCI NCCI Standards of medical / surgical practice 32482 31623 NCCI NCCI Most extensive procedures 32482 31624 NCCI NCCI Most extensive procedures 32482 31625 NCCI NCCI Standards of medical / surgical practice 32482 31643 NCCI NCCI Most extensive procedures 32482 31645 NCCI NCCI Standards of medical / surgical practice 32482 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 134 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32482 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32482 32095 NCCI NCCI Most extensive procedures 32482 32100 NCCI NCCI Most extensive procedures 32482 32140 NCCI NCCI Most extensive procedures 32482 32215 NCCI NCCI Standards of medical / surgical practice 32482 32402 NCCI NCCI Most extensive procedures 32482 32480 NCCI NCCI HCPCS/CPT procedure code definition 32482 32482 BCBST 32482 32484 NCCI NCCI Mutually exclusive procedures 32482 32486 NCCI NCCI Mutually exclusive procedures 32482 32810 NCCI NCCI Standards of medical / surgical practice 32482 32815 NCCI NCCI Standards of medical / surgical practice 32482 32997 NCCI NCCI Most extensive procedures 32482 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 39010 NCCI NCCI Most extensive procedures 32482 39220 NCCI NCCI Most extensive procedures 32482 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64416 NCCI Misuse of Column 2 code with Column 1 code 32482 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64420 NCCI NCCI Anesthesia included in surgical procedures 32482 64421 NCCI NCCI Anesthesia included in surgical procedures 32482 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 64620 NCCI NCCI Standards of medical / surgical practice 32482 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32482 90780 NCCI NCCI Standards of medical / surgical practice 32482 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32484 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32484 31622 NCCI NCCI Standards of medical / surgical practice 32484 31623 NCCI NCCI Most extensive procedures 32484 31624 NCCI NCCI Most extensive procedures 32484 31625 NCCI NCCI Standards of medical / surgical practice 32484 31643 NCCI NCCI Most extensive procedures 32484 31645 NCCI NCCI Standards of medical / surgical practice 32484 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 135 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32484 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32484 32095 NCCI NCCI Most extensive procedures 32484 32100 NCCI NCCI Most extensive procedures 32484 32140 NCCI NCCI Most extensive procedures 32484 32215 NCCI NCCI Standards of medical / surgical practice 32484 32402 NCCI NCCI Most extensive procedures 32484 32484 BCBST 32484 32810 NCCI NCCI Standards of medical / surgical practice 32484 32815 NCCI NCCI Standards of medical / surgical practice 32484 32997 NCCI NCCI Most extensive procedures 32484 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 39010 NCCI NCCI Most extensive procedures 32484 39220 NCCI NCCI Most extensive procedures 32484 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64416 NCCI Misuse of Column 2 code with Column 1 code 32484 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64421 NCCI NCCI Anesthesia included in surgical procedures 32484 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 64620 NCCI NCCI Standards of medical / surgical practice 32484 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32484 90780 NCCI NCCI Standards of medical / surgical practice 32484 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32486 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32486 31622 NCCI NCCI Standards of medical / surgical practice 32486 31623 NCCI NCCI Most extensive procedures 32486 31624 NCCI NCCI Most extensive procedures 32486 31625 NCCI NCCI Standards of medical / surgical practice 32486 31643 NCCI NCCI Most extensive procedures 32486 31645 NCCI NCCI Standards of medical / surgical practice 32486 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32486 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32486 32095 NCCI NCCI Most extensive procedures 32486 32100 NCCI NCCI Most extensive procedures 32486 32140 NCCI NCCI Most extensive procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 136 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32486 32215 32486 32486 Source Rationale NCCI NCCI Standards of medical / surgical practice 32402 NCCI NCCI Most extensive procedures 32486 BCBST 32486 32810 NCCI NCCI Standards of medical / surgical practice 32486 32815 NCCI NCCI Standards of medical / surgical practice 32486 32997 NCCI NCCI Most extensive procedures 32486 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 39010 NCCI NCCI Most extensive procedures 32486 39220 NCCI NCCI Most extensive procedures 32486 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64416 NCCI Misuse of Column 2 code with Column 1 code 32486 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64421 NCCI NCCI Anesthesia included in surgical procedures 32486 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 64620 NCCI NCCI Standards of medical / surgical practice 32486 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32486 90780 NCCI NCCI Standards of medical / surgical practice 32486 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32488 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32488 31622 NCCI NCCI Standards of medical / surgical practice 32488 31623 NCCI NCCI Most extensive procedures 32488 31624 NCCI NCCI Most extensive procedures 32488 31625 NCCI NCCI Standards of medical / surgical practice 32488 31643 NCCI NCCI Most extensive procedures 32488 31645 NCCI NCCI Standards of medical / surgical practice 32488 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32488 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32488 32095 NCCI NCCI Most extensive procedures 32488 32100 NCCI NCCI Most extensive procedures 32488 32140 NCCI NCCI Most extensive procedures 32488 32215 NCCI NCCI Standards of medical / surgical practice 32488 32402 NCCI NCCI Most extensive procedures 32488 32488 BCBST CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 137 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32488 32810 NCCI NCCI Standards of medical / surgical practice 32488 32815 NCCI NCCI Standards of medical / surgical practice 32488 32997 NCCI NCCI Most extensive procedures 32488 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 39010 NCCI NCCI Most extensive procedures 32488 39220 NCCI NCCI Most extensive procedures 32488 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64416 NCCI Misuse of Column 2 code with Column 1 code 32488 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64421 NCCI NCCI Anesthesia included in surgical procedures 32488 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 64620 NCCI NCCI Standards of medical / surgical practice 32488 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32488 90780 NCCI NCCI Standards of medical / surgical practice 32488 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32491 31622 NCCI NCCI Sequential procedures 32491 31645 NCCI NCCI Sequential procedures 32491 32002 NCCI NCCI Most extensive procedures 32491 32005 NCCI NCCI Most extensive procedures 32491 32020 NCCI NCCI Most extensive procedures 32491 32095 NCCI NCCI Most extensive procedures 32491 32100 NCCI NCCI Most extensive procedures 32491 32110 NCCI NCCI Most extensive procedures 32491 32120 NCCI NCCI Most extensive procedures 32491 32124 NCCI NCCI Most extensive procedures 32491 32140 NCCI NCCI Most extensive procedures 32491 32141 NCCI NCCI Most extensive procedures 32491 32200 NCCI NCCI Most extensive procedures 32491 32215 NCCI NCCI Most extensive procedures 32491 32220 NCCI NCCI Most extensive procedures 32491 32225 NCCI NCCI Most extensive procedures 32491 32310 NCCI NCCI Most extensive procedures 32491 32320 NCCI NCCI Most extensive procedures 32491 32400 NCCI NCCI Most extensive procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 138 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32491 32402 NCCI NCCI Most extensive procedures 32491 32420 NCCI NCCI Most extensive procedures 32491 32442 NCCI NCCI Mutually exclusive procedures 32491 32445 NCCI NCCI Mutually exclusive procedures 32491 32488 NCCI NCCI Mutually exclusive procedures 32491 32491 BCBST 32491 32522 NCCI NCCI Mutually exclusive procedures 32491 32525 NCCI NCCI Mutually exclusive procedures 32491 32601 NCCI NCCI Sequential procedures 32491 32602 NCCI NCCI Sequential procedures 32491 32650 NCCI NCCI Sequential procedures 32491 32651 NCCI NCCI Sequential procedures 32491 32652 NCCI NCCI Sequential procedures 32491 32653 NCCI NCCI Sequential procedures 32491 32654 NCCI NCCI Sequential procedures 32491 32655 NCCI NCCI Sequential procedures 32491 32656 NCCI NCCI Sequential procedures 32491 32820 NCCI NCCI Most extensive procedures 32491 32905 NCCI NCCI Most extensive procedures 32491 32940 NCCI NCCI Most extensive procedures 32491 32960 NCCI NCCI Sequential procedures 32491 32997 NCCI NCCI Most extensive procedures 32491 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 39010 NCCI NCCI Most extensive procedures 32491 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 64416 NCCI Misuse of Column 2 code with Column 1 code 32491 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32491 90780 NCCI NCCI Standards of medical / surgical practice 32491 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32500 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32500 31645 NCCI NCCI Most extensive procedures 32500 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 139 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32500 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32500 32095 NCCI NCCI Most extensive procedures 32500 32100 NCCI NCCI Standards of medical / surgical practice 32500 32140 NCCI NCCI Most extensive procedures 32500 32402 NCCI NCCI Most extensive procedures 32500 32484 NCCI NCCI Mutually exclusive procedures 32500 32500 BCBST 32500 32810 NCCI NCCI Standards of medical / surgical practice 32500 32815 NCCI NCCI Standards of medical / surgical practice 32500 35820 NCCI NCCI Standards of medical / surgical practice 32500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 39010 NCCI NCCI Most extensive procedures 32500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64416 NCCI Misuse of Column 2 code with Column 1 code 32500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64421 NCCI NCCI Anesthesia included in surgical procedures 32500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 64620 NCCI NCCI Most extensive procedures 32500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32500 90780 NCCI NCCI Standards of medical / surgical practice 32500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32501 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32520 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32520 31622 NCCI NCCI Most extensive procedures 32520 31623 NCCI NCCI Most extensive procedures 32520 31624 NCCI NCCI Most extensive procedures 32520 31625 NCCI NCCI Sequential procedures 32520 31643 NCCI NCCI Most extensive procedures 32520 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32520 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32520 32095 NCCI NCCI Most extensive procedures 32520 32100 NCCI NCCI Most extensive procedures 32520 32402 NCCI NCCI Most extensive procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 140 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32520 32491 NCCI 32520 32520 BCBST 32520 32810 NCCI NCCI Standards of medical / surgical practice 32520 32815 NCCI NCCI Standards of medical / surgical practice 32520 32820 NCCI NCCI HCPCS/CPT procedure code definition 32520 32900 NCCI NCCI Standards of medical / surgical practice 32520 32997 NCCI NCCI Most extensive procedures 32520 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 39010 NCCI NCCI Most extensive procedures 32520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 64416 NCCI Misuse of Column 2 code with Column 1 code 32520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32520 90780 NCCI NCCI Standards of medical / surgical practice 32520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32522 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32522 31622 NCCI NCCI Most extensive procedures 32522 31623 NCCI NCCI Most extensive procedures 32522 31624 NCCI NCCI Most extensive procedures 32522 31625 NCCI NCCI Sequential procedures 32522 31643 NCCI NCCI Most extensive procedures 32522 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32522 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32522 32095 NCCI NCCI Most extensive procedures 32522 32100 NCCI NCCI Most extensive procedures 32522 32402 NCCI NCCI Most extensive procedures 32522 32522 BCBST 32522 32810 NCCI NCCI Standards of medical / surgical practice 32522 32815 NCCI NCCI Standards of medical / surgical practice 32522 32820 NCCI NCCI HCPCS/CPT procedure code definition 32522 32900 NCCI NCCI Standards of medical / surgical practice 32522 32905 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI Mutually exclusive procedures 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 141 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32522 32906 NCCI NCCI Standards of medical / surgical practice 32522 32997 NCCI NCCI Most extensive procedures 32522 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 39010 NCCI NCCI Most extensive procedures 32522 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 64416 NCCI Misuse of Column 2 code with Column 1 code 32522 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32522 90780 NCCI NCCI Standards of medical / surgical practice 32522 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32525 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32525 31623 NCCI NCCI Most extensive procedures 32525 31624 NCCI NCCI Most extensive procedures 32525 31625 NCCI NCCI Sequential procedures 32525 31643 NCCI NCCI Most extensive procedures 32525 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32525 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32525 32095 NCCI NCCI Most extensive procedures 32525 32100 NCCI NCCI Most extensive procedures 32525 32402 NCCI NCCI Most extensive procedures 32525 32525 BCBST 32525 32810 NCCI NCCI Standards of medical / surgical practice 32525 32815 NCCI NCCI Standards of medical / surgical practice 32525 32820 NCCI NCCI HCPCS/CPT procedure code definition 32525 32900 NCCI NCCI Standards of medical / surgical practice 32525 32905 NCCI NCCI Standards of medical / surgical practice 32525 32906 NCCI NCCI Standards of medical / surgical practice 32525 32997 NCCI NCCI Most extensive procedures 32525 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 39010 NCCI NCCI Most extensive procedures 32525 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 142 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32525 64416 NCCI Misuse of Column 2 code with Column 1 code 32525 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32525 90780 NCCI NCCI Standards of medical / surgical practice 32525 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32540 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32540 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32540 32095 NCCI NCCI Most extensive procedures 32540 32100 NCCI NCCI Most extensive procedures 32540 32220 NCCI NCCI HCPCS/CPT separate procedure definition 32540 32225 NCCI NCCI HCPCS/CPT separate procedure definition 32540 32402 NCCI NCCI Most extensive procedures 32540 32540 BCBST 32540 32810 NCCI NCCI Standards of medical / surgical practice 32540 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 64416 NCCI Misuse of Column 2 code with Column 1 code 32540 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32540 90780 NCCI NCCI Standards of medical / surgical practice 32540 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32601 00528 NCCI NCCI Anesthesia included in surgical procedures 32601 00539 NCCI Anesthesia included in surgical procedures 32601 00540 NCCI Anesthesia included in surgical procedures 32601 00541 NCCI Anesthesia included in surgical procedures 32601 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32601 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32601 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32601 32601 BCBST CPT TM Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 143 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32601 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 64416 NCCI Misuse of Column 2 code with Column 1 code 32601 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 64420 NCCI Misuse of Column 2 code with Column 1 code 32601 64421 NCCI Misuse of Column 2 code with Column 1 code 32601 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32601 90780 NCCI NCCI Standards of medical / surgical practice 32601 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32602 00528 NCCI NCCI Anesthesia included in surgical procedures 32602 00539 NCCI Anesthesia included in surgical procedures 32602 00540 NCCI Anesthesia included in surgical procedures 32602 00541 NCCI Anesthesia included in surgical procedures 32602 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32602 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32602 32005 NCCI NCCI Standards of medical / surgical practice 32602 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32602 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32602 32602 BCBST 32602 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 64416 NCCI Misuse of Column 2 code with Column 1 code 32602 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 64420 NCCI Misuse of Column 2 code with Column 1 code 32602 64421 NCCI Misuse of Column 2 code with Column 1 code 32602 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32602 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 144 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32602 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32603 00528 NCCI NCCI Anesthesia included in surgical procedures 32603 00539 NCCI Anesthesia included in surgical procedures 32603 00540 NCCI Anesthesia included in surgical procedures 32603 00541 NCCI Anesthesia included in surgical procedures 32603 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32603 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32603 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32603 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32603 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32603 32603 BCBST 32603 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 64416 NCCI Misuse of Column 2 code with Column 1 code 32603 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 64420 NCCI Misuse of Column 2 code with Column 1 code 32603 64421 NCCI Misuse of Column 2 code with Column 1 code 32603 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32603 90780 NCCI NCCI Standards of medical / surgical practice 32603 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32604 00528 NCCI NCCI Anesthesia included in surgical procedures 32604 00539 NCCI Anesthesia included in surgical procedures 32604 00540 NCCI Anesthesia included in surgical procedures 32604 00541 NCCI Anesthesia included in surgical procedures 32604 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32604 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32604 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32604 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32604 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32604 32604 BCBST 32604 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32604 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 145 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32604 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 64416 NCCI Misuse of Column 2 code with Column 1 code 32604 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 64420 NCCI Misuse of Column 2 code with Column 1 code 32604 64421 NCCI Misuse of Column 2 code with Column 1 code 32604 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32604 90780 NCCI NCCI Standards of medical / surgical practice 32604 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32605 00528 NCCI NCCI Anesthesia included in surgical procedures 32605 00539 NCCI Anesthesia included in surgical procedures 32605 00540 NCCI Anesthesia included in surgical procedures 32605 00541 NCCI Anesthesia included in surgical procedures 32605 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32605 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32605 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32605 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32605 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32605 32605 BCBST 32605 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 64416 NCCI Misuse of Column 2 code with Column 1 code 32605 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 64420 NCCI Misuse of Column 2 code with Column 1 code 32605 64421 NCCI Misuse of Column 2 code with Column 1 code 32605 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32605 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 146 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32605 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32606 00528 NCCI NCCI Anesthesia included in surgical procedures 32606 00539 NCCI Anesthesia included in surgical procedures 32606 00540 NCCI Anesthesia included in surgical procedures 32606 00541 NCCI Anesthesia included in surgical procedures 32606 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32606 32606 BCBST 32606 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 64416 NCCI Misuse of Column 2 code with Column 1 code 32606 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 64420 NCCI Misuse of Column 2 code with Column 1 code 32606 64421 NCCI Misuse of Column 2 code with Column 1 code 32606 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32606 90780 NCCI NCCI Standards of medical / surgical practice 32606 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32650 00528 NCCI NCCI Anesthesia included in surgical procedures 32650 00539 NCCI Anesthesia included in surgical procedures 32650 00540 NCCI Anesthesia included in surgical procedures 32650 00541 NCCI Anesthesia included in surgical procedures 32650 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32005 NCCI NCCI HCPCS/CPT procedure code definition 32650 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32215 NCCI NCCI Standards of medical / surgical practice 32650 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32602 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 147 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32650 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32650 32960 NCCI NCCI Standards of medical / surgical practice 32650 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 64416 NCCI Misuse of Column 2 code with Column 1 code 32650 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 64420 NCCI Misuse of Column 2 code with Column 1 code 32650 64421 NCCI Misuse of Column 2 code with Column 1 code 32650 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32650 90780 NCCI NCCI Standards of medical / surgical practice 32650 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32651 00528 NCCI NCCI Anesthesia included in surgical procedures 32651 00539 NCCI Anesthesia included in surgical procedures 32651 00540 NCCI Anesthesia included in surgical procedures 32651 00541 NCCI Anesthesia included in surgical procedures 32651 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32320 NCCI NCCI HCPCS/CPT procedure code definition 32651 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32651 32960 NCCI NCCI Standards of medical / surgical practice 32651 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 148 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32651 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 64420 NCCI Misuse of Column 2 code with Column 1 code 32651 64421 NCCI Misuse of Column 2 code with Column 1 code 32651 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32651 90780 NCCI NCCI Standards of medical / surgical practice 32651 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32652 00528 NCCI NCCI Anesthesia included in surgical procedures 32652 00539 NCCI Anesthesia included in surgical procedures 32652 00540 NCCI Anesthesia included in surgical procedures 32652 00541 NCCI Anesthesia included in surgical procedures 32652 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32124 NCCI NCCI Standards of medical / surgical practice 32652 32320 NCCI NCCI HCPCS/CPT procedure code definition 32652 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32652 32940 NCCI NCCI Mutually exclusive procedures 32652 32960 NCCI NCCI Standards of medical / surgical practice 32652 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 64416 NCCI Misuse of Column 2 code with Column 1 code 32652 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 64420 NCCI Misuse of Column 2 code with Column 1 code 32652 64421 NCCI Misuse of Column 2 code with Column 1 code 32652 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32652 90780 NCCI NCCI Standards of medical / surgical practice 32652 S0020 CPT CMS 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 TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 149 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32653 00528 NCCI NCCI Anesthesia included in surgical procedures 32653 00539 NCCI Anesthesia included in surgical procedures 32653 00540 NCCI Anesthesia included in surgical procedures 32653 00541 NCCI Anesthesia included in surgical procedures 32653 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32653 32960 NCCI NCCI Standards of medical / surgical practice 32653 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 64416 NCCI Misuse of Column 2 code with Column 1 code 32653 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 64420 NCCI Misuse of Column 2 code with Column 1 code 32653 64421 NCCI Misuse of Column 2 code with Column 1 code 32653 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32653 90780 NCCI NCCI Standards of medical / surgical practice 32653 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32654 00528 NCCI NCCI Anesthesia included in surgical procedures 32654 00539 NCCI Anesthesia included in surgical procedures 32654 00540 NCCI Anesthesia included in surgical procedures 32654 00541 NCCI Anesthesia included in surgical procedures 32654 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32654 32606 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 150 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32654 32654 BCBST Code redundant to self/should not be reported more than once due to standard description 32654 32960 NCCI NCCI Standards of medical / surgical practice 32654 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 64416 NCCI Misuse of Column 2 code with Column 1 code 32654 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 64420 NCCI Misuse of Column 2 code with Column 1 code 32654 64421 NCCI Misuse of Column 2 code with Column 1 code 32654 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32654 90780 NCCI NCCI Standards of medical / surgical practice 32654 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32655 00528 NCCI NCCI Anesthesia included in surgical procedures 32655 00539 NCCI Anesthesia included in surgical procedures 32655 00540 NCCI Anesthesia included in surgical procedures 32655 00541 NCCI Anesthesia included in surgical procedures 32655 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32655 32960 NCCI NCCI Standards of medical / surgical practice 32655 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 64416 NCCI Misuse of Column 2 code with Column 1 code 32655 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 64420 NCCI Misuse of Column 2 code with Column 1 code 32655 64421 NCCI Misuse of Column 2 code with Column 1 code 32655 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 151 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32655 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32655 90780 NCCI NCCI Standards of medical / surgical practice 32655 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32656 00528 NCCI NCCI Anesthesia included in surgical procedures 32656 00539 NCCI Anesthesia included in surgical procedures 32656 00540 NCCI Anesthesia included in surgical procedures 32656 00541 NCCI Anesthesia included in surgical procedures 32656 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32656 32320 NCCI NCCI HCPCS/CPT procedure code definition 32656 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32656 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32656 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32656 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32656 32960 NCCI NCCI Standards of medical / surgical practice 32656 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 64416 NCCI Misuse of Column 2 code with Column 1 code 32656 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 64420 NCCI Misuse of Column 2 code with Column 1 code 32656 64421 NCCI Misuse of Column 2 code with Column 1 code 32656 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32656 90780 NCCI NCCI Standards of medical / surgical practice 32656 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32657 00528 NCCI NCCI Anesthesia included in surgical procedures 32657 00539 NCCI Anesthesia included in surgical procedures 32657 00540 NCCI Anesthesia included in surgical procedures 32657 00541 NCCI Anesthesia included in surgical procedures 32657 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32603 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 152 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32657 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32657 32960 NCCI NCCI Standards of medical / surgical practice 32657 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 64416 NCCI Misuse of Column 2 code with Column 1 code 32657 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 64420 NCCI Misuse of Column 2 code with Column 1 code 32657 64421 NCCI Misuse of Column 2 code with Column 1 code 32657 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32657 90780 NCCI NCCI Standards of medical / surgical practice 32657 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32658 00528 NCCI NCCI Anesthesia included in surgical procedures 32658 00539 NCCI Anesthesia included in surgical procedures 32658 00540 NCCI Anesthesia included in surgical procedures 32658 00541 NCCI Anesthesia included in surgical procedures 32658 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32658 32658 BCBST 32658 32960 NCCI NCCI Standards of medical / surgical practice 32658 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 153 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32658 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 64420 NCCI Misuse of Column 2 code with Column 1 code 32658 64421 NCCI Misuse of Column 2 code with Column 1 code 32658 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32658 90780 NCCI NCCI Standards of medical / surgical practice 32658 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32659 00528 NCCI NCCI Anesthesia included in surgical procedures 32659 00539 NCCI Anesthesia included in surgical procedures 32659 00540 NCCI Anesthesia included in surgical procedures 32659 00541 NCCI Anesthesia included in surgical procedures 32659 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32659 32659 BCBST 32659 32960 NCCI NCCI Standards of medical / surgical practice 32659 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 64416 NCCI Misuse of Column 2 code with Column 1 code 32659 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 64420 NCCI Misuse of Column 2 code with Column 1 code 32659 64421 NCCI Misuse of Column 2 code with Column 1 code 32659 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32659 90780 NCCI NCCI Standards of medical / surgical practice 32659 S0020 CPT CMS 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 TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 154 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32660 00528 NCCI NCCI Anesthesia included in surgical procedures 32660 00539 NCCI Anesthesia included in surgical procedures 32660 00540 NCCI Anesthesia included in surgical procedures 32660 00541 NCCI Anesthesia included in surgical procedures 32660 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32660 32660 BCBST 32660 32960 NCCI NCCI Standards of medical / surgical practice 32660 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 64416 NCCI Misuse of Column 2 code with Column 1 code 32660 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 64420 NCCI Misuse of Column 2 code with Column 1 code 32660 64421 NCCI Misuse of Column 2 code with Column 1 code 32660 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32660 90780 NCCI NCCI Standards of medical / surgical practice 32660 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32661 00528 NCCI NCCI Anesthesia included in surgical procedures 32661 00539 NCCI Anesthesia included in surgical procedures 32661 00540 NCCI Anesthesia included in surgical procedures 32661 00541 NCCI Anesthesia included in surgical procedures 32661 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32661 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32661 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32661 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32661 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32661 32604 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 155 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32661 32605 32661 32661 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32661 BCBST 32661 32960 NCCI NCCI Standards of medical / surgical practice 32661 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 64416 NCCI Misuse of Column 2 code with Column 1 code 32661 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 64420 NCCI Misuse of Column 2 code with Column 1 code 32661 64421 NCCI Misuse of Column 2 code with Column 1 code 32661 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32661 90780 NCCI NCCI Standards of medical / surgical practice 32661 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32662 00528 NCCI NCCI Anesthesia included in surgical procedures 32662 00539 NCCI Anesthesia included in surgical procedures 32662 00540 NCCI Anesthesia included in surgical procedures 32662 00541 NCCI Anesthesia included in surgical procedures 32662 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32662 32662 BCBST 32662 32960 NCCI NCCI Standards of medical / surgical practice 32662 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 60520 NCCI NCCI HCPCS/CPT separate procedure definition 32662 60521 NCCI NCCI HCPCS/CPT separate procedure definition 32662 60522 NCCI NCCI HCPCS/CPT separate procedure definition 32662 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 156 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32662 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 64416 NCCI Misuse of Column 2 code with Column 1 code 32662 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 64420 NCCI Misuse of Column 2 code with Column 1 code 32662 64421 NCCI Misuse of Column 2 code with Column 1 code 32662 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32662 90780 NCCI NCCI Standards of medical / surgical practice 32662 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32663 00528 NCCI NCCI Anesthesia included in surgical procedures 32663 00539 NCCI Anesthesia included in surgical procedures 32663 00540 NCCI Anesthesia included in surgical procedures 32663 00541 NCCI Anesthesia included in surgical procedures 32663 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32663 32960 NCCI NCCI Standards of medical / surgical practice 32663 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 64416 NCCI Misuse of Column 2 code with Column 1 code 32663 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 64420 NCCI Misuse of Column 2 code with Column 1 code 32663 64421 NCCI Misuse of Column 2 code with Column 1 code 32663 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32663 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 157 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32663 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32664 00528 NCCI NCCI Anesthesia included in surgical procedures 32664 00539 NCCI Anesthesia included in surgical procedures 32664 00540 NCCI Anesthesia included in surgical procedures 32664 00541 NCCI Anesthesia included in surgical procedures 32664 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32604 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32605 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32664 32960 NCCI NCCI Standards of medical / surgical practice 32664 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 64416 NCCI Misuse of Column 2 code with Column 1 code 32664 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 64420 NCCI Misuse of Column 2 code with Column 1 code 32664 64421 NCCI Misuse of Column 2 code with Column 1 code 32664 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32664 90780 NCCI NCCI Standards of medical / surgical practice 32664 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32665 00528 NCCI NCCI Anesthesia included in surgical procedures 32665 00539 NCCI Anesthesia included in surgical procedures 32665 00540 NCCI Anesthesia included in surgical procedures 32665 00541 NCCI Anesthesia included in surgical procedures 32665 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32665 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32665 32601 NCCI NCCI HCPCS/CPT separate procedure definition 32665 32602 NCCI NCCI HCPCS/CPT separate procedure definition 32665 32603 NCCI NCCI HCPCS/CPT separate procedure definition 32665 32604 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 158 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32665 32605 32665 32665 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 32606 NCCI NCCI HCPCS/CPT separate procedure definition 32665 BCBST 32665 32960 NCCI NCCI Standards of medical / surgical practice 32665 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 64416 NCCI Misuse of Column 2 code with Column 1 code 32665 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 64420 NCCI Misuse of Column 2 code with Column 1 code 32665 64421 NCCI Misuse of Column 2 code with Column 1 code 32665 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32665 90780 NCCI NCCI Standards of medical / surgical practice 32665 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32800 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32800 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32800 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32800 32100 NCCI NCCI Standards of medical / surgical practice 32800 32800 BCBST 32800 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 64416 NCCI Misuse of Column 2 code with Column 1 code 32800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32800 90780 NCCI NCCI Standards of medical / surgical practice 32800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32810 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32810 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 159 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32810 32020 32810 32810 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 32100 NCCI NCCI Standards of medical / surgical practice 32810 BCBST 32810 32905 NCCI NCCI Mutually exclusive procedures 32810 32906 NCCI NCCI Mutually exclusive procedures 32810 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 64416 NCCI Misuse of Column 2 code with Column 1 code 32810 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32810 90780 NCCI NCCI Standards of medical / surgical practice 32810 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32815 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32815 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32815 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32815 32100 NCCI NCCI Standards of medical / surgical practice 32815 32124 NCCI NCCI Standards of medical / surgical practice 32815 32815 BCBST 32815 32906 NCCI NCCI Mutually exclusive procedures 32815 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 64416 NCCI Misuse of Column 2 code with Column 1 code 32815 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32815 90780 NCCI NCCI Standards of medical / surgical practice 32815 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32820 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32820 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 160 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 32820 32020 32820 32820 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 32100 NCCI NCCI Standards of medical / surgical practice 32820 BCBST 32820 32906 NCCI NCCI Mutually exclusive procedures 32820 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 64416 NCCI Misuse of Column 2 code with Column 1 code 32820 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32820 90780 NCCI NCCI Standards of medical / surgical practice 32820 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32850 32440 BCBST 32850 32442 NCCI Misuse of Column 2 code with Column 1 code 32850 32445 NCCI Misuse of Column 2 code with Column 1 code 32850 32480 NCCI Misuse of Column 2 code with Column 1 code 32850 32482 NCCI Misuse of Column 2 code with Column 1 code 32850 32484 NCCI Misuse of Column 2 code with Column 1 code 32850 32486 NCCI Misuse of Column 2 code with Column 1 code 32850 32488 NCCI Misuse of Column 2 code with Column 1 code 32850 32491 NCCI Misuse of Column 2 code with Column 1 code 32850 32500 NCCI Misuse of Column 2 code with Column 1 code 32850 32850 BCBST 32850 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 64416 NCCI Misuse of Column 2 code with Column 1 code 32850 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32850 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. NCCI Refer to Specific Guidelines Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 161 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32850 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32851 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32851 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32851 32440 BCBST NCCI Refer to Specific Guidelines 32851 32442 BCBST NCCI Refer to Specific Guidelines 32851 32491 NCCI NCCI Most extensive procedures 32851 32851 BCBST 32851 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 64416 NCCI Misuse of Column 2 code with Column 1 code 32851 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32851 90780 NCCI NCCI Standards of medical / surgical practice 32851 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32851 S2060 BCBST 32852 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32852 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32852 32440 BCBST NCCI Refer to Specific Guidelines 32852 32442 BCBST NCCI Refer to Specific Guidelines 32852 32491 NCCI NCCI Most extensive procedures 32852 32851 NCCI NCCI "With" versus "without" procedures 32852 32852 BCBST 32852 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 64416 NCCI Misuse of Column 2 code with Column 1 code 32852 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32852 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. This edit is considered a part of the more extensive listed procedure. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 162 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32852 S0020 CPT 32852 S2060 BCBST 32853 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32853 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32853 32440 BCBST NCCI Refer to Specific Guidelines 32853 32442 BCBST NCCI Refer to Specific Guidelines 32853 32491 NCCI NCCI Most extensive procedures 32853 32851 NCCI NCCI HCPCS/CPT procedure code definition 32853 32853 BCBST 32853 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 64416 NCCI Misuse of Column 2 code with Column 1 code 32853 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32853 90780 NCCI NCCI Standards of medical / surgical practice 32853 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32853 S2060 BCBST 32854 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32854 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32854 32440 BCBST NCCI Refer to Specific Guidelines 32854 32442 BCBST NCCI Refer to Specific Guidelines 32854 32491 NCCI NCCI Most extensive procedures 32854 32852 NCCI NCCI HCPCS/CPT procedure code definition 32854 32853 NCCI NCCI "With" versus "without" procedures 32854 32854 BCBST 32854 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 64416 NCCI Misuse of Column 2 code with Column 1 code 32854 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 CPT TM CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package This edit is considered a part of the more extensive listed procedure. Code redundant to self/should not be reported more than once due to standard description This edit is considered a part of the more extensive listed procedure. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 163 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32854 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32854 90780 NCCI NCCI Standards of medical / surgical practice 32854 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32854 S2060 BCBST 32900 20101 NCCI NCCI HCPCS/CPT separate procedure definition 32900 32100 NCCI NCCI Most extensive procedures 32900 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 64416 NCCI Misuse of Column 2 code with Column 1 code 32900 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32900 90780 NCCI NCCI Standards of medical / surgical practice 32900 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32905 32100 NCCI NCCI Most extensive procedures 32905 32820 NCCI NCCI Mutually exclusive procedures 32905 32900 NCCI NCCI Most extensive procedures 32905 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 64416 NCCI Misuse of Column 2 code with Column 1 code 32905 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32905 90780 NCCI NCCI Standards of medical / surgical practice 32905 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32906 32100 NCCI NCCI Most extensive procedures 32906 32491 NCCI NCCI Most extensive procedures CPT TM This edit is considered a part of the more extensive listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 164 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32906 32900 NCCI NCCI Most extensive procedures 32906 32905 NCCI NCCI HCPCS/CPT procedure code definition 32906 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 64416 NCCI Misuse of Column 2 code with Column 1 code 32906 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32906 90780 NCCI NCCI Standards of medical / surgical practice 32906 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32940 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 64416 NCCI Misuse of Column 2 code with Column 1 code 32940 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32940 90780 NCCI NCCI Standards of medical / surgical practice 32940 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32960 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 64416 NCCI Misuse of Column 2 code with Column 1 code 32960 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32960 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 165 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 32960 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32997 31500 NCCI NCCI Standards of medical / surgical practice 32997 31525 NCCI NCCI Most extensive procedures 32997 31526 NCCI NCCI Most extensive procedures 32997 31575 NCCI NCCI Most extensive procedures 32997 31622 NCCI NCCI HCPCS/CPT separate procedure definition 32997 31624 NCCI NCCI Most extensive procedures 32997 31700 NCCI NCCI HCPCS/CPT separate procedure definition 32997 31720 NCCI NCCI HCPCS/CPT separate procedure definition 32997 31725 NCCI NCCI HCPCS/CPT separate procedure definition 32997 32420 NCCI NCCI Most extensive procedures 32997 32997 BCBST 32997 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 64416 NCCI Misuse of Column 2 code with Column 1 code 32997 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 32997 76000 NCCI NCCI HCPCS/CPT separate procedure definition 32997 76001 NCCI NCCI Standards of medical / surgical practice 32997 76003 NCCI NCCI Standards of medical / surgical practice 32997 90780 NCCI NCCI Standards of medical / surgical practice 32997 92511 NCCI NCCI HCPCS/CPT separate procedure definition 32997 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 32999 32999 BCBST 32999 S0020 CPT 33010 33010 BCBST 33010 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 64416 NCCI Misuse of Column 2 code with Column 1 code 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 CPT TM Code redundant to self/should not be reported more than once due to standard description Procedure redundant to itself. CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 166 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33010 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33010 90780 NCCI NCCI Standards of medical / surgical practice 33010 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33011 33011 BCBST 33011 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 64416 NCCI Misuse of Column 2 code with Column 1 code 33011 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33011 90780 NCCI NCCI Standards of medical / surgical practice 33011 99261 BCBST 33011 99262 BCBST 33011 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33015 33010 NCCI NCCI Standards of medical / surgical practice 33015 33011 NCCI NCCI Standards of medical / surgical practice 33015 33015 BCBST 33015 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 64416 NCCI Misuse of Column 2 code with Column 1 code 33015 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33015 90780 NCCI NCCI Standards of medical / surgical practice 33015 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33020 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. HCPCS/CPT coding manual instruction/guideline HCPCS/CPT coding manual instruction/guideline Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 167 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33020 32020 NCCI 33020 33020 BCBST 33020 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33020 33141 NCCI NCCI Standards of medical / surgical practice 33020 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 64416 NCCI Misuse of Column 2 code with Column 1 code 33020 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33020 90780 NCCI NCCI Standards of medical / surgical practice 33020 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33025 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33025 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33025 32659 NCCI NCCI Most extensive procedures 33025 33015 NCCI NCCI Standards of medical / surgical practice 33025 33020 NCCI NCCI Most extensive procedures 33025 33025 BCBST 33025 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33025 33141 NCCI NCCI Standards of medical / surgical practice 33025 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 64416 NCCI Misuse of Column 2 code with Column 1 code 33025 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33025 90780 NCCI NCCI Standards of medical / surgical practice 33025 S0020 CPT CMS 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 TM NCCI HCPCS/CPT separate procedure definition Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 168 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33030 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33030 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33030 33020 NCCI NCCI Standards of medical / surgical practice 33030 33025 NCCI NCCI Most extensive procedures 33030 33030 BCBST 33030 33050 NCCI NCCI Most extensive procedures 33030 33141 NCCI NCCI Standards of medical / surgical practice 33030 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 64416 NCCI Misuse of Column 2 code with Column 1 code 33030 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33030 90780 NCCI NCCI Standards of medical / surgical practice 33030 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33031 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33031 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33031 32100 NCCI NCCI Standards of medical / surgical practice 33031 33020 NCCI NCCI Most extensive procedures 33031 33025 NCCI NCCI Most extensive procedures 33031 33030 NCCI NCCI "With" versus "without" procedures 33031 33031 BCBST 33031 33050 NCCI NCCI Most extensive procedures 33031 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33031 33141 NCCI NCCI Standards of medical / surgical practice 33031 35226 NCCI NCCI Standards of medical / surgical practice 33031 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 64416 NCCI Misuse of Column 2 code with Column 1 code 33031 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 169 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33031 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33031 90780 NCCI NCCI Standards of medical / surgical practice 33031 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33050 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33050 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33050 33050 BCBST 33050 33130 NCCI NCCI Mutually exclusive procedures 33050 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33050 33141 NCCI NCCI Standards of medical / surgical practice 33050 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 64416 NCCI Misuse of Column 2 code with Column 1 code 33050 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33050 90780 NCCI NCCI Standards of medical / surgical practice 33050 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33120 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33120 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33120 33120 BCBST 33120 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33120 33141 NCCI NCCI Standards of medical / surgical practice 33120 35226 NCCI NCCI Standards of medical / surgical practice 33120 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 64416 NCCI Misuse of Column 2 code with Column 1 code 33120 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 170 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33120 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33120 90780 NCCI NCCI Standards of medical / surgical practice 33120 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33130 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33130 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33130 33130 BCBST 33130 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33130 33141 NCCI NCCI Standards of medical / surgical practice 33130 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 64416 NCCI Misuse of Column 2 code with Column 1 code 33130 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33130 90780 NCCI NCCI Standards of medical / surgical practice 33130 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33140 33140 BCBST 33140 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 64416 NCCI Misuse of Column 2 code with Column 1 code 33140 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33140 90780 NCCI NCCI Standards of medical / surgical practice 33140 S0020 CPT CMS 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 TM Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 171 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33141 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 33141 21750 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32002 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32020 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32095 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32100 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32110 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 32160 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 33030 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 33031 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 33210 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 172 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33141 33211 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 39010 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33141 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33200 00530 NCCI NCCI Anesthesia included in surgical procedures 33200 00534 NCCI NCCI Anesthesia included in surgical procedures 33200 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33200 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33200 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33200 33141 NCCI NCCI Standards of medical / surgical practice 33200 33200 BCBST Code redundant to self/should not be reported more than once due to standard description 33200 33215 BCBST Electrode placement is included in the listed procedure. 33200 33224 BCBST Code 33224 is not typically performed in conjunction with the listed procedure. 33200 33225 BCBST Code 33225 is not typically performed in conjunction with the listed procedure. 33200 33226 BCBST Code 33226 is not typically performed in conjunction with the listed procedure. 33200 36000 NCCI NCCI Standards of medical / surgical practice 33200 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 64416 NCCI Misuse of Column 2 code with Column 1 code 33200 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33200 76000 NCCI Standards of medical / surgical practice 33200 76001 NCCI Standards of medical / surgical practice 33200 90780 NCCI NCCI Standards of medical / surgical practice 33200 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33201 00530 NCCI NCCI Anesthesia included in surgical procedures 33201 00534 NCCI NCCI Anesthesia included in surgical procedures 33201 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33201 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33201 33200 NCCI NCCI Mutually exclusive procedures 33201 33201 BCBST CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 173 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33201 33215 BCBST Electrode placement is included in the listed procedure. 33201 33224 BCBST Code 33224 is not typically performed in conjunction with the listed procedure. 33201 33225 BCBST Code 33225 is not typically performed in conjunction with the listed procedure. 33201 33226 BCBST Code 33226 is not typically performed in conjunction with the listed procedure. 33201 36000 NCCI NCCI Standards of medical / surgical practice 33201 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 64416 NCCI Misuse of Column 2 code with Column 1 code 33201 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33201 76000 NCCI Standards of medical / surgical practice 33201 76001 NCCI Standards of medical / surgical practice 33201 90780 NCCI NCCI Standards of medical / surgical practice 33201 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33206 00530 NCCI NCCI Anesthesia included in surgical procedures 33206 00534 NCCI NCCI Anesthesia included in surgical procedures 33206 33206 BCBST 33206 33210 NCCI NCCI Most extensive procedures 33206 33211 NCCI NCCI Most extensive procedures 33206 33212 NCCI NCCI Standards of medical / surgical practice 33206 33213 NCCI NCCI Standards of medical / surgical practice 33206 33215 BCBST Electrode placement is included in the listed procedure. 33206 33224 BCBST Code 33225 should be used in conjunction with this code. 33206 36000 NCCI NCCI Standards of medical / surgical practice 33206 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 64416 NCCI Misuse of Column 2 code with Column 1 code 33206 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 174 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33206 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33206 76000 NCCI Standards of medical / surgical practice 33206 76001 NCCI Standards of medical / surgical practice 33206 90780 NCCI NCCI Standards of medical / surgical practice 33206 93602 NCCI NCCI Standards of medical / surgical practice 33206 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33207 00530 NCCI NCCI Anesthesia included in surgical procedures 33207 00534 NCCI NCCI Anesthesia included in surgical procedures 33207 33207 BCBST 33207 33214 NCCI 33207 33215 BCBST 33207 33218 NCCI 33207 33224 BCBST 33207 36000 NCCI NCCI Standards of medical / surgical practice 33207 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 64416 NCCI Misuse of Column 2 code with Column 1 code 33207 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33207 76000 NCCI NCCI Standards of medical / surgical practice 33207 76001 NCCI Standards of medical / surgical practice 33207 90780 NCCI NCCI Standards of medical / surgical practice 33207 92960 NCCI NCCI Standards of medical / surgical practice 33207 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33208 00530 NCCI NCCI Anesthesia included in surgical procedures 33208 00534 NCCI NCCI Anesthesia included in surgical procedures 33208 33206 NCCI NCCI HCPCS/CPT procedure code definition 33208 33207 NCCI NCCI HCPCS/CPT procedure code definition 33208 33208 BCBST 33208 33214 NCCI 33215 BCBST 33208 CPT TM Code redundant to self/should not be reported more than once due to standard description NCCI Mutually exclusive procedures Electrode placement is included in the listed procedure. NCCI Sequential procedures Code 33225 should be used in conjunction with this code. Code redundant to self/should not be reported more than once due to standard description NCCI Mutually exclusive procedures Electrode placement is included in the listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 175 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33208 33224 BCBST Code 33225 should be used in conjunction with this code. 33208 36000 NCCI NCCI Standards of medical / surgical practice 33208 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 64416 NCCI Misuse of Column 2 code with Column 1 code 33208 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33208 76000 NCCI Standards of medical / surgical practice 33208 76001 NCCI Standards of medical / surgical practice 33208 90780 NCCI NCCI Standards of medical / surgical practice 33208 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33210 00530 NCCI NCCI Anesthesia included in surgical procedures 33210 00534 NCCI NCCI Anesthesia included in surgical procedures 33210 33210 BCBST 33210 36000 NCCI NCCI Standards of medical / surgical practice 33210 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 64416 NCCI Misuse of Column 2 code with Column 1 code 33210 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33210 76000 NCCI Standards of medical / surgical practice 33210 76001 NCCI Standards of medical / surgical practice 33210 90780 NCCI NCCI Standards of medical / surgical practice 33210 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33211 00530 NCCI NCCI Anesthesia included in surgical procedures 33211 00534 NCCI NCCI Anesthesia included in surgical procedures 33211 33210 NCCI NCCI HCPCS/CPT procedure code definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 176 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33211 33211 BCBST Code redundant to self/should not be reported more than once due to standard description 33211 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 64416 NCCI Misuse of Column 2 code with Column 1 code 33211 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33211 76000 NCCI Standards of medical / surgical practice 33211 76001 NCCI Standards of medical / surgical practice 33211 90780 NCCI NCCI Standards of medical / surgical practice 33211 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33212 00530 NCCI NCCI Anesthesia included in surgical procedures 33212 00534 NCCI NCCI Anesthesia included in surgical procedures 33212 33212 BCBST 33212 33217 NCCI NCCI Mutually exclusive procedures 33212 33222 NCCI NCCI Standards of medical / surgical practice 33212 36000 NCCI NCCI Standards of medical / surgical practice 33212 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 64416 NCCI Misuse of Column 2 code with Column 1 code 33212 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33212 90780 NCCI NCCI Standards of medical / surgical practice 33212 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33213 00530 NCCI NCCI Anesthesia included in surgical procedures 33213 00534 NCCI NCCI Anesthesia included in surgical procedures 33213 33213 BCBST CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 177 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33213 36000 NCCI NCCI Standards of medical / surgical practice 33213 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 64416 NCCI Misuse of Column 2 code with Column 1 code 33213 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33213 90780 NCCI NCCI Standards of medical / surgical practice 33213 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33214 00530 NCCI NCCI Anesthesia included in surgical procedures 33214 00534 NCCI NCCI Anesthesia included in surgical procedures 33214 33214 BCBST Code redundant to self/should not be reported more than once due to standard description 33214 33215 BCBST Electrode placement is included in the listed procedure. 33214 33233 BCBST NCCI Refer to Specific Guidelines 33214 36000 NCCI NCCI Standards of medical / surgical practice 33214 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 64416 NCCI Misuse of Column 2 code with Column 1 code 33214 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33214 76000 NCCI Standards of medical / surgical practice 33214 76001 NCCI Standards of medical / surgical practice 33214 90780 NCCI NCCI Standards of medical / surgical practice 33214 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33215 00530 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 178 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33215 00534 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33215 00540 NCCI 33215 33210 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33215 33211 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33215 33215 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 33215 33220 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33215 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. 33215 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. 33215 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. 33215 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. 33215 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 TM Anesthesia included in surgical procedures is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 179 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33215 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. 33215 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. 33215 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. 33215 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. 33215 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. 33215 76000 NCCI Standards of medical / surgical practice 33215 76001 NCCI Standards of medical / surgical practice 33215 90780 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. 33215 92950 BCBST 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. 33215 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33216 00530 NCCI NCCI Anesthesia included in surgical procedures 33216 00534 NCCI NCCI Anesthesia included in surgical procedures 33216 33212 NCCI NCCI Mutually exclusive procedures 33216 33215 BCBST Electrode placement is included in the listed procedure. 33216 33216 BCBST Code redundant to self/should not be reported more than once due to standard description 33216 33220 NCCI CPT TM NCCI Mutually exclusive procedures is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 180 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33216 36000 NCCI NCCI Standards of medical / surgical practice 33216 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 64416 NCCI Misuse of Column 2 code with Column 1 code 33216 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33216 76000 NCCI Standards of medical / surgical practice 33216 76001 NCCI Standards of medical / surgical practice 33216 90780 NCCI NCCI Standards of medical / surgical practice 33216 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33217 00530 NCCI NCCI Anesthesia included in surgical procedures 33217 00534 NCCI NCCI Anesthesia included in surgical procedures 33217 33206 NCCI NCCI Mutually exclusive procedures 33217 33207 NCCI NCCI Mutually exclusive procedures 33217 33215 BCBST Electrode placement is included in the listed procedure. 33217 33217 BCBST Code redundant to self/should not be reported more than once due to standard description 33217 33220 NCCI NCCI Mutually exclusive procedures 33217 36000 NCCI NCCI Standards of medical / surgical practice 33217 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 64416 NCCI Misuse of Column 2 code with Column 1 code 33217 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33217 76000 NCCI Standards of medical / surgical practice 33217 76001 NCCI Standards of medical / surgical practice 33217 90780 NCCI NCCI Standards of medical / surgical practice 33217 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33218 00530 NCCI NCCI Anesthesia included in surgical procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 181 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33218 00534 NCCI 33218 33215 BCBST 33218 33216 NCCI 33218 33218 BCBST 33218 33249 NCCI NCCI Mutually exclusive procedures 33218 36000 NCCI NCCI Standards of medical / surgical practice 33218 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 64416 NCCI Misuse of Column 2 code with Column 1 code 33218 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33218 76000 NCCI Standards of medical / surgical practice 33218 76001 NCCI Standards of medical / surgical practice 33218 90780 NCCI NCCI Standards of medical / surgical practice 33218 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33220 00530 NCCI NCCI Anesthesia included in surgical procedures 33220 00534 NCCI NCCI Anesthesia included in surgical procedures 33220 33215 BCBST 33220 33218 NCCI 33220 33220 BCBST 33220 33249 NCCI NCCI Mutually exclusive procedures 33220 36000 NCCI NCCI Standards of medical / surgical practice 33220 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 64416 NCCI Misuse of Column 2 code with Column 1 code 33220 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33220 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Anesthesia included in surgical procedures Electrode placement is included in the listed procedure. NCCI Mutually exclusive procedures Code redundant to self/should not be reported more than once due to standard description Electrode placement is included in the listed procedure. NCCI Mutually exclusive procedures Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 182 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33220 76000 NCCI Standards of medical / surgical practice 33220 76001 NCCI Standards of medical / surgical practice 33220 90780 NCCI NCCI Standards of medical / surgical practice 33220 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33222 00530 NCCI NCCI Anesthesia included in surgical procedures 33222 00534 NCCI NCCI Anesthesia included in surgical procedures 33222 33215 NCCI Standards of medical / surgical practice 33222 33222 BCBST 33222 36000 NCCI NCCI Standards of medical / surgical practice 33222 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 64416 NCCI Misuse of Column 2 code with Column 1 code 33222 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33222 90780 NCCI NCCI Standards of medical / surgical practice 33222 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33223 00530 NCCI NCCI Anesthesia included in surgical procedures 33223 00534 NCCI NCCI Anesthesia included in surgical procedures 33223 33215 NCCI Standards of medical / surgical practice 33223 33223 BCBST 33223 36000 NCCI NCCI Standards of medical / surgical practice 33223 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 64416 NCCI Misuse of Column 2 code with Column 1 code 33223 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33223 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 90780 NCCI NCCI Standards of medical / surgical practice 33223 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 183 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33223 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33224 00530 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33224 00540 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33224 33212 BCBST Edited code is incompatible or redundant to the listed procedure. 33224 33213 BCBST Edited code is incompatible or redundant to the listed procedure. 33224 33214 BCBST Edited code is incompatible or redundant to the listed procedure. 33224 33215 BCBST Edited code not allowed if used to report repositioning in combination with the listed procedure. 33224 33222 BCBST Edited code not allowed if used to report revision or relocation of skin pocket included in the listed procedure. 33224 33223 BCBST Edited code not allowed if used to report revision of skin pocket included in the listed procedure. 33224 33224 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 33224 33225 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33224 33226 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33224 33233 BCBST Edited code not allowed if used to report generator removal included in the listed procedure. 33224 33240 BCBST The services provided by this edited code in combination with the listed procedure may be covered by another more encompassing code. Review before reimbursing to verify that another code or code combination is not more appropriate for the procedure performed. 33224 33241 BCBST Edited code not allowed if used to report generator removal included in the listed procedure. 33224 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. 33224 36011 NCCI Standards of medical / surgical practice 33224 36012 NCCI Standards of medical / surgical practice 33224 37202 BCBST CPT TM 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. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 184 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33224 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. 33224 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. 33224 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. 33224 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. 33224 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. 33224 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. 33224 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 185 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33224 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. 33224 75860 NCCI Misuse of Column 2 code with Column 1 code 33224 76000 NCCI Standards of medical / surgical practice 33224 76001 NCCI Standards of medical / surgical practice 33224 90780 BCBST 33224 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33225 00530 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33225 00540 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33225 33215 BCBST Edited code not allowed if used to report repositioning in combination with the listed procedure. 33225 33218 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33225 33220 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33225 33223 BCBST This code combination represents an incompatible linkage with conflicting, overlapping, or mutually exclusive elements. 33225 33225 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 33225 33241 BCBST Edited code not allowed if used to report generator removal in combination with the listed procedure. 33225 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. 33225 36011 NCCI Standards of medical / surgical practice 33225 36012 NCCI Standards of medical / surgical practice 33225 37202 BCBST CPT TM 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. 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. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 186 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33225 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. 33225 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. 33225 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. 33225 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. 33225 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. 33225 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. 33225 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 187 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33225 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. 33225 75860 NCCI Misuse of Column 2 code with Column 1 code 33225 76000 NCCI Standards of medical / surgical practice 33225 76001 NCCI Standards of medical / surgical practice 33225 90780 BCBST 33225 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33226 00530 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33226 00540 BCBST The edited code is a component of the listed code if used to report minor anesthesia services provided as part of the listed procedure. As per CPT Surgical Package Definition, local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is included in the surgical package. Similar listed codes with edit disallowed according to NCCI anesthesia included in surgical procedures policy, which indicates that when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure. 33226 33206 NCCI Mutually exclusive procedures 33226 33207 NCCI Mutually exclusive procedures 33226 33208 NCCI Mutually exclusive procedures 33226 33211 NCCI Mutually exclusive procedures 33226 33212 BCBST Edited code not allowed when used to report insertion or replacement of pulse generator included as part of the definitive procedure. 33226 33213 BCBST Edited code not allowed when used to report insertion or replacement of pulse generator included as part of the definitive procedure. 33226 33214 NCCI 33226 33215 BCBST 33226 33216 NCCI Mutually exclusive procedures 33226 33217 NCCI Mutually exclusive procedures 33226 33218 NCCI Mutually exclusive procedures 33226 33220 NCCI Mutually exclusive procedures 33226 33222 BCBST Edited code not allowed if used to report revision of skin pocket included in the listed procedure. 33226 33223 BCBST Edited code not allowed if used to report revision of skin pocket included in the listed procedure. 33226 33226 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 33226 33233 BCBST Edited code not allowed if used to report generator removal included in the listed procedure. CPT TM 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. Mutually exclusive procedures Edited code not allowed if used to report repositioning in combination with the listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 188 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33226 33234 33226 33226 Source Rationale NCCI Mutually exclusive procedures 33235 NCCI Mutually exclusive procedures 33240 BCBST Edited code not allowed if used to report generator insertion included in the listed procedure. 33226 33241 BCBST Edited code not allowed if used to report generator removal included in the listed procedure. 33226 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. 33226 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. 33226 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. 33226 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. 33226 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. 33226 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 189 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33226 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. 33226 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. 33226 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. 33226 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. 33226 76000 NCCI 33226 76001 NCCI 33226 90780 BCBST 33226 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33233 00530 NCCI NCCI Anesthesia included in surgical procedures 33233 00534 NCCI NCCI Anesthesia included in surgical procedures 33233 33215 NCCI Misuse of Column 2 code with Column 1 code 33233 33233 BCBST 33233 33237 NCCI NCCI Mutually exclusive procedures 33233 36000 NCCI NCCI Standards of medical / surgical practice 33233 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 64416 NCCI Misuse of Column 2 code with Column 1 code 33233 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Standards of medical / surgical practice Standards of medical / surgical practice 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. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 190 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33233 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33233 90780 NCCI NCCI Standards of medical / surgical practice 33233 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33234 00530 NCCI NCCI Anesthesia included in surgical procedures 33234 00534 NCCI NCCI Anesthesia included in surgical procedures 33234 33215 NCCI Misuse of Column 2 code with Column 1 code 33234 33234 BCBST 33234 36000 NCCI NCCI Standards of medical / surgical practice 33234 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 64416 NCCI Misuse of Column 2 code with Column 1 code 33234 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33234 76000 NCCI Standards of medical / surgical practice 33234 76001 NCCI Standards of medical / surgical practice 33234 90780 NCCI NCCI Standards of medical / surgical practice 33234 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33235 00530 NCCI NCCI Anesthesia included in surgical procedures 33235 00534 NCCI NCCI Anesthesia included in surgical procedures 33235 33215 NCCI Misuse of Column 2 code with Column 1 code 33235 33235 BCBST 33235 36000 NCCI NCCI Standards of medical / surgical practice 33235 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 64416 NCCI Misuse of Column 2 code with Column 1 code 33235 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 191 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33235 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33235 76000 NCCI Standards of medical / surgical practice 33235 76001 NCCI Standards of medical / surgical practice 33235 90780 NCCI NCCI Standards of medical / surgical practice 33235 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33236 00530 NCCI NCCI Anesthesia included in surgical procedures 33236 00534 NCCI NCCI Anesthesia included in surgical procedures 33236 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33236 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33236 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33236 33141 NCCI NCCI Standards of medical / surgical practice 33236 33215 NCCI Misuse of Column 2 code with Column 1 code 33236 33236 BCBST 33236 33238 NCCI NCCI Mutually exclusive procedures 33236 36000 NCCI NCCI Standards of medical / surgical practice 33236 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 64416 NCCI Misuse of Column 2 code with Column 1 code 33236 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33236 90780 NCCI NCCI Standards of medical / surgical practice 33236 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33237 00530 NCCI NCCI Anesthesia included in surgical procedures 33237 00534 NCCI NCCI Anesthesia included in surgical procedures 33237 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33237 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33237 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33237 33141 NCCI NCCI Standards of medical / surgical practice 33237 33215 NCCI Misuse of Column 2 code with Column 1 code 33237 33237 BCBST 33237 33238 NCCI NCCI Mutually exclusive procedures 36000 NCCI NCCI Standards of medical / surgical practice 33237 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 192 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33237 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 64416 NCCI Misuse of Column 2 code with Column 1 code 33237 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33237 90780 NCCI NCCI Standards of medical / surgical practice 33237 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33238 00530 NCCI NCCI Anesthesia included in surgical procedures 33238 00534 NCCI NCCI Anesthesia included in surgical procedures 33238 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33238 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33238 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33238 33141 NCCI NCCI Standards of medical / surgical practice 33238 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33238 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33238 33215 NCCI Misuse of Column 2 code with Column 1 code 33238 33238 BCBST 33238 36000 NCCI NCCI Standards of medical / surgical practice 33238 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 64416 NCCI Misuse of Column 2 code with Column 1 code 33238 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33238 90780 NCCI NCCI Standards of medical / surgical practice 33238 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33240 00530 NCCI NCCI Anesthesia included in surgical procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 193 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33240 00534 NCCI NCCI Anesthesia included in surgical procedures 33240 33215 NCCI Standards of medical / surgical practice 33240 33223 NCCI NCCI Standards of medical / surgical practice 33240 33240 BCBST 33240 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 64416 NCCI Misuse of Column 2 code with Column 1 code 33240 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33240 90780 NCCI NCCI Standards of medical / surgical practice 33240 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33241 00530 NCCI NCCI Anesthesia included in surgical procedures 33241 00534 NCCI NCCI Anesthesia included in surgical procedures 33241 33215 NCCI Standards of medical / surgical practice 33241 33223 NCCI NCCI Mutually exclusive procedures 33241 33241 BCBST 33241 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 64416 NCCI Misuse of Column 2 code with Column 1 code 33241 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33241 90780 NCCI NCCI Standards of medical / surgical practice 33241 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33243 00530 NCCI NCCI Anesthesia included in surgical procedures 33243 00534 NCCI NCCI Anesthesia included in surgical procedures 33243 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33243 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33243 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 194 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33243 33141 NCCI NCCI Standards of medical / surgical practice 33243 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33243 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33243 33215 NCCI Misuse of Column 2 code with Column 1 code 33243 33243 BCBST 33243 36000 NCCI NCCI Standards of medical / surgical practice 33243 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 64416 NCCI Misuse of Column 2 code with Column 1 code 33243 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33243 76000 NCCI Standards of medical / surgical practice 33243 76001 NCCI Standards of medical / surgical practice 33243 90780 NCCI NCCI Standards of medical / surgical practice 33243 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33244 00530 NCCI NCCI Anesthesia included in surgical procedures 33244 00534 NCCI NCCI Anesthesia included in surgical procedures 33244 33215 NCCI Misuse of Column 2 code with Column 1 code 33244 33244 BCBST 33244 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 64416 NCCI Misuse of Column 2 code with Column 1 code 33244 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33244 76000 NCCI Standards of medical / surgical practice 33244 76001 NCCI Standards of medical / surgical practice CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 195 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33244 90780 NCCI NCCI Standards of medical / surgical practice 33244 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33245 00530 NCCI NCCI Anesthesia included in surgical procedures 33245 00534 NCCI NCCI Anesthesia included in surgical procedures 33245 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33245 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33245 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33245 33141 NCCI NCCI Standards of medical / surgical practice 33245 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33245 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33245 33215 BCBST Electrode placement is included in the listed procedure. 33245 33224 BCBST Code 33224 is not typically performed in conjunction with the listed procedure. 33245 33225 BCBST Code 33225 is not typically performed in conjunction with the listed procedure. 33245 33226 BCBST Code 33226 is not typically performed in conjunction with the listed procedure. 33245 33245 BCBST Code redundant to self/should not be reported more than once due to standard description 33245 36000 NCCI NCCI Standards of medical / surgical practice 33245 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 64416 NCCI Misuse of Column 2 code with Column 1 code 33245 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33245 76000 NCCI Standards of medical / surgical practice 33245 76001 NCCI Standards of medical / surgical practice 33245 90780 NCCI NCCI Standards of medical / surgical practice 33245 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33246 00530 NCCI NCCI Anesthesia included in surgical procedures 33246 00534 NCCI NCCI Anesthesia included in surgical procedures 33246 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33246 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33246 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33246 33141 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 196 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33246 33210 33246 33246 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33215 BCBST Electrode placement is included in the listed procedure. 33246 33224 BCBST Code 33224 is not typically performed in conjunction with the listed procedure. 33246 33225 BCBST Code 33225 is not typically performed in conjunction with the listed procedure. 33246 33226 BCBST Code 33226 is not typically performed in conjunction with the listed procedure. 33246 33245 NCCI 33246 33246 BCBST 33246 36000 NCCI NCCI Standards of medical / surgical practice 33246 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 64416 NCCI Misuse of Column 2 code with Column 1 code 33246 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33246 76000 NCCI Standards of medical / surgical practice 33246 76001 NCCI Standards of medical / surgical practice 33246 90780 NCCI NCCI Standards of medical / surgical practice 33246 93640 NCCI NCCI Standards of medical / surgical practice 33246 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33249 00530 NCCI NCCI Anesthesia included in surgical procedures 33249 00534 NCCI NCCI Anesthesia included in surgical procedures 33249 33215 BCBST 33249 33216 NCCI NCCI Most extensive procedures 33249 33216 NCCI NCCI Most extensive procedures 33249 33216 NCCI NCCI Most extensive procedures 33249 33216 NCCI NCCI Most extensive procedures 33249 33217 NCCI NCCI Most extensive procedures 33249 33224 BCBST Code 33225 should be used in conjunction with this code. 33249 33226 BCBST Electrode repositioning is included in the listed procedure. 33249 33249 BCBST Code redundant to self/should not be reported more than once due to standard description 33249 37202 NCCI CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description Electrode placement is included in the listed procedure. NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 197 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33249 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 64416 NCCI Misuse of Column 2 code with Column 1 code 33249 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33249 76000 NCCI Standards of medical / surgical practice 33249 76001 NCCI Standards of medical / surgical practice 33249 90780 NCCI NCCI Standards of medical / surgical practice 33249 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33250 00537 NCCI NCCI Anesthesia included in surgical procedures 33250 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33250 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33250 33141 NCCI NCCI Standards of medical / surgical practice 33250 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33250 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33250 33250 BCBST 33250 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 64416 NCCI Misuse of Column 2 code with Column 1 code 33250 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33250 90780 NCCI NCCI Standards of medical / surgical practice 33250 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33251 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33251 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33251 33140 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 198 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33251 33141 NCCI NCCI Standards of medical / surgical practice 33251 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33251 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33251 33250 NCCI NCCI "With" versus "without" procedures 33251 33251 BCBST 33251 35226 NCCI NCCI Standards of medical / surgical practice 33251 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 64416 NCCI Misuse of Column 2 code with Column 1 code 33251 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33251 90780 NCCI NCCI Standards of medical / surgical practice 33251 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33253 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33253 33141 NCCI NCCI Standards of medical / surgical practice 33253 33253 BCBST 33253 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 64416 NCCI Misuse of Column 2 code with Column 1 code 33253 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33253 90780 NCCI NCCI Standards of medical / surgical practice 33253 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33261 00537 NCCI NCCI Anesthesia included in surgical procedures 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33261 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 199 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33261 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33261 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33261 33141 NCCI NCCI Standards of medical / surgical practice 33261 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33261 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33261 33261 BCBST 33261 35226 NCCI NCCI Standards of medical / surgical practice 33261 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 64416 NCCI Misuse of Column 2 code with Column 1 code 33261 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33261 90780 NCCI NCCI Standards of medical / surgical practice 33261 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33282 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33282 33141 NCCI NCCI Standards of medical / surgical practice 33282 33282 BCBST 33282 36000 NCCI NCCI Standards of medical / surgical practice 33282 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 64416 NCCI Misuse of Column 2 code with Column 1 code 33282 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33282 90780 NCCI NCCI Standards of medical / surgical practice 33282 93727 NCCI NCCI Standards of medical / surgical practice 33282 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33284 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 200 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33284 33141 33284 33284 Source Rationale NCCI NCCI Standards of medical / surgical practice 33282 NCCI NCCI Mutually exclusive procedures 33284 BCBST 33284 36000 NCCI NCCI Standards of medical / surgical practice 33284 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 64416 NCCI Misuse of Column 2 code with Column 1 code 33284 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33284 90780 NCCI NCCI Standards of medical / surgical practice 33284 93727 NCCI NCCI HCPCS/CPT procedure code definition 33284 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33300 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33300 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33300 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33300 33141 NCCI NCCI Standards of medical / surgical practice 33300 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33300 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33300 33300 BCBST 33300 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 64416 NCCI Misuse of Column 2 code with Column 1 code 33300 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33300 90780 NCCI NCCI Standards of medical / surgical practice 33300 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33305 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 201 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33305 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33305 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33305 33141 NCCI NCCI Standards of medical / surgical practice 33305 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33305 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33305 33300 NCCI NCCI "With" versus "without" procedures 33305 33305 BCBST 33305 35226 NCCI NCCI Standards of medical / surgical practice 33305 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 64416 NCCI Misuse of Column 2 code with Column 1 code 33305 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33305 90780 NCCI NCCI Standards of medical / surgical practice 33305 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33310 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33310 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33310 33020 NCCI NCCI Most extensive procedures 33310 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33310 33141 NCCI NCCI Standards of medical / surgical practice 33310 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33310 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33310 33310 BCBST 33310 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 64416 NCCI Misuse of Column 2 code with Column 1 code 33310 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 202 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33310 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33310 90780 NCCI NCCI Standards of medical / surgical practice 33310 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33315 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33315 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33315 33020 NCCI NCCI Most extensive procedures 33315 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33315 33141 NCCI NCCI Standards of medical / surgical practice 33315 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33315 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33315 33310 NCCI NCCI "With" versus "without" procedures 33315 33315 BCBST 33315 35226 NCCI NCCI Standards of medical / surgical practice 33315 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 64416 NCCI Misuse of Column 2 code with Column 1 code 33315 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33315 90780 NCCI NCCI Standards of medical / surgical practice 33315 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33320 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33320 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33320 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33320 33141 NCCI NCCI Standards of medical / surgical practice 33320 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33320 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33320 33320 BCBST 33320 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 203 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33320 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 64416 NCCI Misuse of Column 2 code with Column 1 code 33320 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33320 90780 NCCI NCCI Standards of medical / surgical practice 33320 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33321 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33321 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33321 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33321 33141 NCCI NCCI Standards of medical / surgical practice 33321 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33321 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33321 33320 NCCI NCCI "With" versus "without" procedures 33321 33321 BCBST 33321 33330 NCCI NCCI Most extensive procedures 33321 35226 NCCI NCCI Standards of medical / surgical practice 33321 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 64416 NCCI Misuse of Column 2 code with Column 1 code 33321 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33321 90780 NCCI NCCI Standards of medical / surgical practice 33321 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33322 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33322 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33322 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33322 33141 NCCI NCCI Standards of medical / surgical practice 33322 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33322 33211 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 204 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33322 33320 NCCI 33322 33322 BCBST 33322 35226 NCCI NCCI Standards of medical / surgical practice 33322 35820 NCCI NCCI Standards of medical / surgical practice 33322 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 64416 NCCI Misuse of Column 2 code with Column 1 code 33322 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33322 90780 NCCI NCCI Standards of medical / surgical practice 33322 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33330 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33330 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33330 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33330 33141 NCCI NCCI Standards of medical / surgical practice 33330 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33330 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33330 33330 BCBST 33330 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 64416 NCCI Misuse of Column 2 code with Column 1 code 33330 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33330 90780 NCCI NCCI Standards of medical / surgical practice 33330 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33332 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM NCCI "With" versus "without" procedures Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 205 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33332 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33332 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33332 33141 NCCI NCCI Standards of medical / surgical practice 33332 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33332 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33332 33320 NCCI NCCI Most extensive procedures 33332 33321 NCCI NCCI Most extensive procedures 33332 33322 NCCI NCCI Most extensive procedures 33332 33330 NCCI NCCI "With" versus "without" procedures 33332 33332 BCBST 33332 35226 NCCI NCCI Standards of medical / surgical practice 33332 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 64416 NCCI Misuse of Column 2 code with Column 1 code 33332 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33332 90780 NCCI NCCI Standards of medical / surgical practice 33332 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33335 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33335 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33335 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33335 33141 NCCI NCCI Standards of medical / surgical practice 33335 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33335 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33335 33330 NCCI NCCI "With" versus "without" procedures 33335 33335 BCBST 33335 35226 NCCI NCCI Standards of medical / surgical practice 33335 35820 NCCI NCCI Standards of medical / surgical practice 33335 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 206 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33335 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 64416 NCCI Misuse of Column 2 code with Column 1 code 33335 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33335 90780 NCCI NCCI Standards of medical / surgical practice 33335 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33400 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33400 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33400 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33400 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33400 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33400 33400 BCBST 33400 33403 NCCI NCCI Mutually exclusive procedures 33400 33416 NCCI NCCI Standards of medical / surgical practice 33400 35226 NCCI NCCI Standards of medical / surgical practice 33400 35820 NCCI NCCI Standards of medical / surgical practice 33400 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 64416 NCCI Misuse of Column 2 code with Column 1 code 33400 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33400 90780 NCCI NCCI Standards of medical / surgical practice 33400 92986 NCCI NCCI Most extensive procedures 33400 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33401 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33401 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33401 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33401 33210 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 207 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33401 33211 NCCI 33401 33310 BCBST 33401 33400 NCCI 33401 33401 BCBST 33401 33416 NCCI NCCI Standards of medical / surgical practice 33401 35226 NCCI NCCI Standards of medical / surgical practice 33401 35820 NCCI NCCI Standards of medical / surgical practice 33401 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 64416 NCCI Misuse of Column 2 code with Column 1 code 33401 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33401 90780 NCCI NCCI Standards of medical / surgical practice 33401 92986 NCCI NCCI Most extensive procedures 33401 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33403 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33403 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33403 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33403 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33403 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33403 33315 BCBST NCCI Refer to Specific Guidelines 33403 33403 BCBST Code redundant to self/should not be reported more than once due to standard description 33403 33416 NCCI NCCI Standards of medical / surgical practice 33403 35226 NCCI NCCI Standards of medical / surgical practice 33403 35820 NCCI NCCI Standards of medical / surgical practice 33403 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT separate procedure definition NCCI Refer to Specific Guidelines NCCI Mutually exclusive procedures Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 208 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33403 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33403 90780 NCCI NCCI Standards of medical / surgical practice 33403 92986 NCCI NCCI Most extensive procedures 33403 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33404 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33404 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33404 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33404 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33404 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33404 33404 BCBST 33404 33602 NCCI NCCI Mutually exclusive procedures 33404 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 64416 NCCI Misuse of Column 2 code with Column 1 code 33404 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33404 90780 NCCI NCCI Standards of medical / surgical practice 33404 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33405 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33405 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33405 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33405 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33405 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33405 33315 BCBST NCCI Refer to Specific Guidelines 33405 33405 BCBST Code redundant to self/should not be reported more than once due to standard description 33405 33410 NCCI NCCI Mutually exclusive procedures 33411 NCCI NCCI Mutually exclusive procedures 33405 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 209 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33405 33412 NCCI NCCI Mutually exclusive procedures 33405 35226 NCCI NCCI Standards of medical / surgical practice 33405 35820 NCCI NCCI Standards of medical / surgical practice 33405 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 64416 NCCI Misuse of Column 2 code with Column 1 code 33405 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33405 90780 NCCI NCCI Standards of medical / surgical practice 33405 92986 NCCI NCCI Most extensive procedures 33405 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33406 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33406 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33406 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33406 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33406 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33406 33315 BCBST NCCI Refer to Specific Guidelines 33406 33406 BCBST Code redundant to self/should not be reported more than once due to standard description 33406 33410 NCCI NCCI Mutually exclusive procedures 33406 33412 NCCI NCCI Mutually exclusive procedures 33406 33416 NCCI NCCI Standards of medical / surgical practice 33406 35226 NCCI NCCI Standards of medical / surgical practice 33406 35820 NCCI NCCI Standards of medical / surgical practice 33406 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 64416 NCCI Misuse of Column 2 code with Column 1 code 33406 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 210 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33406 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33406 90780 NCCI NCCI Standards of medical / surgical practice 33406 92986 NCCI NCCI Most extensive procedures 33406 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33410 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33410 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33410 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33410 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33410 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33410 33310 BCBST NCCI Refer to Specific Guidelines 33410 33315 BCBST NCCI Refer to Specific Guidelines 33410 33410 BCBST Code redundant to self/should not be reported more than once due to standard description 33410 35226 NCCI NCCI Standards of medical / surgical practice 33410 35820 NCCI NCCI Standards of medical / surgical practice 33410 36000 NCCI NCCI Standards of medical / surgical practice 33410 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 64416 NCCI Misuse of Column 2 code with Column 1 code 33410 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33410 90780 NCCI NCCI Standards of medical / surgical practice 33410 92986 NCCI NCCI Most extensive procedures 33410 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33411 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33411 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33411 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33411 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33411 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33411 33400 NCCI NCCI Most extensive procedures 33411 33401 NCCI NCCI Most extensive procedures CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 211 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33411 33403 33411 33411 Source Rationale NCCI NCCI Most extensive procedures 33406 NCCI NCCI Mutually exclusive procedures 33411 BCBST 33411 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 64416 NCCI Misuse of Column 2 code with Column 1 code 33411 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33411 90780 NCCI NCCI Standards of medical / surgical practice 33411 92986 NCCI NCCI Most extensive procedures 33411 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33412 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33412 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33412 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33412 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33412 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33412 33400 NCCI NCCI Most extensive procedures 33412 33401 NCCI NCCI Sequential procedures 33412 33403 NCCI NCCI Sequential procedures 33412 33412 BCBST 33412 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 64416 NCCI Misuse of Column 2 code with Column 1 code 33412 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33412 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 212 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33412 Source Rationale 90780 NCCI 33412 92986 NCCI NCCI Most extensive procedures 33412 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33413 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33413 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33413 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33413 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33413 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33413 33315 BCBST NCCI Refer to Specific Guidelines 33413 33413 BCBST Code redundant to self/should not be reported more than once due to standard description 33413 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 64416 NCCI Misuse of Column 2 code with Column 1 code 33413 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33413 90780 NCCI NCCI Standards of medical / surgical practice 33413 92986 NCCI NCCI Most extensive procedures 33413 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33414 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33414 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33414 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33414 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33414 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33414 33315 BCBST 33414 33411 NCCI NCCI Mutually exclusive procedures 33414 33412 NCCI NCCI Mutually exclusive procedures 33414 33413 NCCI NCCI Mutually exclusive procedures 33414 33414 BCBST 33414 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 213 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33414 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 64416 NCCI Misuse of Column 2 code with Column 1 code 33414 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33414 90780 NCCI NCCI Standards of medical / surgical practice 33414 92986 NCCI NCCI Most extensive procedures 33414 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33415 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33415 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33415 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33415 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33415 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33415 33415 BCBST 33415 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 64416 NCCI Misuse of Column 2 code with Column 1 code 33415 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33415 90780 NCCI NCCI Standards of medical / surgical practice 33415 92986 NCCI NCCI Most extensive procedures 33415 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33416 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33416 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33416 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33416 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33416 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33416 33310 BCBST CPT TM Code redundant to self/should not be reported more than once due to standard description NCCI Refer to Specific Guidelines is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 214 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33416 33416 BCBST Code redundant to self/should not be reported more than once due to standard description 33416 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 64416 NCCI Misuse of Column 2 code with Column 1 code 33416 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33416 90780 NCCI NCCI Standards of medical / surgical practice 33416 92986 NCCI NCCI Most extensive procedures 33416 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33417 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33417 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33417 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33417 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33417 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33417 33417 BCBST 33417 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 64416 NCCI Misuse of Column 2 code with Column 1 code 33417 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33417 90780 NCCI NCCI Standards of medical / surgical practice 33417 92986 NCCI NCCI Most extensive procedures 33417 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33420 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33420 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 215 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33420 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33420 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33420 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33420 33420 BCBST 33420 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 64416 NCCI Misuse of Column 2 code with Column 1 code 33420 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33420 90780 NCCI NCCI Standards of medical / surgical practice 33420 92987 NCCI NCCI Sequential procedures 33420 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33422 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33422 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33422 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33422 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33422 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33422 33420 NCCI NCCI Sequential procedures 33422 33422 BCBST 33422 35226 NCCI NCCI Standards of medical / surgical practice 33422 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 64416 NCCI Misuse of Column 2 code with Column 1 code 33422 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33422 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 216 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33422 Source Rationale 90780 NCCI 33422 92987 NCCI NCCI Most extensive procedures 33422 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33425 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33425 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33425 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33425 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33425 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33425 33425 BCBST 33425 33430 NCCI NCCI Mutually exclusive procedures 33425 35226 NCCI NCCI Standards of medical / surgical practice 33425 35820 NCCI NCCI Standards of medical / surgical practice 33425 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 64416 NCCI Misuse of Column 2 code with Column 1 code 33425 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33425 90780 NCCI NCCI Standards of medical / surgical practice 33425 92987 NCCI NCCI Sequential procedures 33425 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33426 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33426 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33426 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33426 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33426 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33426 33310 BCBST NCCI Refer to Specific Guidelines 33426 33315 BCBST NCCI Refer to Specific Guidelines 33426 33425 NCCI 33426 33426 BCBST 33426 33430 NCCI NCCI Mutually exclusive procedures 33600 NCCI NCCI Mutually exclusive procedures 33426 CPT TM NCCI Standards of medical / surgical practice Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 217 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33426 35226 NCCI NCCI Standards of medical / surgical practice 33426 35820 NCCI NCCI Standards of medical / surgical practice 33426 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 64416 NCCI Misuse of Column 2 code with Column 1 code 33426 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33426 90780 NCCI NCCI Standards of medical / surgical practice 33426 92987 NCCI NCCI Sequential procedures 33426 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33427 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33427 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33427 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33427 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33427 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33427 33310 BCBST NCCI Refer to Specific Guidelines 33427 33315 BCBST NCCI Refer to Specific Guidelines 33427 33425 NCCI 33427 33427 BCBST 33427 35226 NCCI NCCI Standards of medical / surgical practice 33427 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 64416 NCCI Misuse of Column 2 code with Column 1 code 33427 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33427 90780 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 218 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33427 92987 NCCI NCCI Most extensive procedures 33427 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33430 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33430 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33430 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33430 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33430 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33430 33310 BCBST NCCI Refer to Specific Guidelines 33430 33315 BCBST NCCI Refer to Specific Guidelines 33430 33427 NCCI 33430 33430 BCBST 33430 35226 NCCI NCCI Standards of medical / surgical practice 33430 35820 NCCI NCCI Standards of medical / surgical practice 33430 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 64416 NCCI Misuse of Column 2 code with Column 1 code 33430 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33430 90780 NCCI NCCI Standards of medical / surgical practice 33430 92987 NCCI NCCI Sequential procedures 33430 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33460 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33460 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33460 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33460 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33460 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33460 33460 BCBST 33460 33463 NCCI NCCI Most extensive procedures 33460 33465 NCCI NCCI Mutually exclusive procedures 33460 35226 NCCI NCCI Standards of medical / surgical practice 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 CPT TM NCCI Mutually exclusive procedures 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 219 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33460 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 64416 NCCI Misuse of Column 2 code with Column 1 code 33460 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33460 90780 NCCI NCCI Standards of medical / surgical practice 33460 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33463 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33463 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33463 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33463 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33463 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33463 33463 BCBST 33463 35820 NCCI NCCI Standards of medical / surgical practice 33463 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 64416 NCCI Misuse of Column 2 code with Column 1 code 33463 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33463 90780 NCCI NCCI Standards of medical / surgical practice 33463 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33464 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33464 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33464 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33464 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33464 33211 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 220 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33464 33460 33464 33464 Source Rationale NCCI NCCI Most extensive procedures 33463 NCCI NCCI "With" versus "without" procedures 33464 BCBST 33464 35820 NCCI NCCI Standards of medical / surgical practice 33464 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 64416 NCCI Misuse of Column 2 code with Column 1 code 33464 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33464 90780 NCCI NCCI Standards of medical / surgical practice 33464 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33465 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33465 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33465 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33465 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33465 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33465 33465 BCBST 33465 33468 NCCI NCCI Sequential procedures 33465 33600 NCCI NCCI Mutually exclusive procedures 33465 35226 NCCI NCCI Standards of medical / surgical practice 33465 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 64416 NCCI Misuse of Column 2 code with Column 1 code 33465 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33465 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 221 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33465 90780 NCCI NCCI Standards of medical / surgical practice 33465 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33468 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33468 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33468 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33468 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33468 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33468 33460 NCCI NCCI Most extensive procedures 33468 33468 BCBST 33468 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 64416 NCCI Misuse of Column 2 code with Column 1 code 33468 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33468 90780 NCCI NCCI Standards of medical / surgical practice 33468 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33470 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33470 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33470 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33470 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33470 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33470 33470 BCBST 33470 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 64416 NCCI Misuse of Column 2 code with Column 1 code 33470 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 222 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33470 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33470 90780 NCCI NCCI Standards of medical / surgical practice 33470 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33471 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33471 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33471 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33471 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33471 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33471 33471 BCBST 33471 33474 NCCI NCCI Most extensive procedures 33471 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 64416 NCCI Misuse of Column 2 code with Column 1 code 33471 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33471 90780 NCCI NCCI Standards of medical / surgical practice 33471 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33472 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33472 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33472 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33472 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33472 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33472 33470 NCCI NCCI Most extensive procedures 33472 33471 NCCI NCCI Most extensive procedures 33472 33472 BCBST 33472 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 223 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33472 64416 NCCI Misuse of Column 2 code with Column 1 code 33472 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33472 90780 NCCI NCCI Standards of medical / surgical practice 33472 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33474 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33474 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33474 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33474 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33474 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33474 33470 NCCI NCCI Most extensive procedures 33474 33472 NCCI NCCI Mutually exclusive procedures 33474 33474 BCBST 33474 35226 NCCI NCCI Standards of medical / surgical practice 33474 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 64416 NCCI Misuse of Column 2 code with Column 1 code 33474 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33474 90780 NCCI NCCI Standards of medical / surgical practice 33474 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33475 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33475 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33475 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33475 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33475 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33475 33470 NCCI NCCI Most extensive procedures 33475 33471 NCCI NCCI Most extensive procedures CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 224 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33475 33472 33475 33475 Source Rationale NCCI NCCI Most extensive procedures 33474 NCCI NCCI Most extensive procedures 33475 BCBST 33475 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 64416 NCCI Misuse of Column 2 code with Column 1 code 33475 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33475 90780 NCCI NCCI Standards of medical / surgical practice 33475 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33476 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33476 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33476 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33476 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33476 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33476 33476 BCBST 33476 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 64416 NCCI Misuse of Column 2 code with Column 1 code 33476 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33476 90780 NCCI NCCI Standards of medical / surgical practice 33476 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33478 32002 NCCI NCCI HCPCS/CPT separate procedure definition 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33478 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 225 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33478 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33478 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33478 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33478 33478 BCBST 33478 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 64416 NCCI Misuse of Column 2 code with Column 1 code 33478 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33478 90780 NCCI NCCI Standards of medical / surgical practice 33478 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33496 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33496 33310 BCBST NCCI Refer to Specific Guidelines 33496 33315 BCBST NCCI Refer to Specific Guidelines 33496 33496 BCBST Code redundant to self/should not be reported more than once due to standard description 33496 35226 NCCI NCCI Standards of medical / surgical practice 33496 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 64416 NCCI Misuse of Column 2 code with Column 1 code 33496 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33496 90780 NCCI NCCI Standards of medical / surgical practice 33496 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33500 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33500 32020 NCCI NCCI HCPCS/CPT separate procedure definition 32100 NCCI NCCI Standards of medical / surgical practice 33500 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 226 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33500 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33500 33141 NCCI NCCI Standards of medical / surgical practice 33500 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33500 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33500 33310 BCBST NCCI Refer to Specific Guidelines 33500 33315 BCBST NCCI Refer to Specific Guidelines 33500 33500 BCBST Code redundant to self/should not be reported more than once due to standard description 33500 33501 NCCI NCCI "With" versus "without" procedures 33500 35226 NCCI NCCI Standards of medical / surgical practice 33500 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 64416 NCCI Misuse of Column 2 code with Column 1 code 33500 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33500 90780 NCCI NCCI Standards of medical / surgical practice 33500 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33500 92995 NCCI NCCI Most extensive procedures 33500 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33501 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33501 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33501 32100 NCCI NCCI Standards of medical / surgical practice 33501 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33501 33141 NCCI NCCI Standards of medical / surgical practice 33501 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33501 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33501 33310 BCBST NCCI Refer to Specific Guidelines 33501 33501 BCBST Code redundant to self/should not be reported more than once due to standard description 33501 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 227 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33501 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 64416 NCCI Misuse of Column 2 code with Column 1 code 33501 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33501 90780 NCCI NCCI Standards of medical / surgical practice 33501 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33501 92995 NCCI NCCI Most extensive procedures 33501 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33502 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33502 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33502 32100 NCCI NCCI Standards of medical / surgical practice 33502 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33502 33141 NCCI NCCI Standards of medical / surgical practice 33502 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33502 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33502 33502 BCBST 33502 33503 NCCI NCCI Mutually exclusive procedures 33502 33505 NCCI NCCI Mutually exclusive procedures 33502 33506 NCCI NCCI Mutually exclusive procedures 33502 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 64416 NCCI Misuse of Column 2 code with Column 1 code 33502 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33502 90780 NCCI NCCI Standards of medical / surgical practice 33502 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33502 92995 NCCI NCCI Most extensive procedures 33502 S0020 CPT CMS 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 TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 228 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33503 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33503 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33503 32100 NCCI NCCI Standards of medical / surgical practice 33503 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33503 33141 NCCI NCCI Standards of medical / surgical practice 33503 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33503 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33503 33503 BCBST 33503 33505 NCCI NCCI Mutually exclusive procedures 33503 33506 NCCI NCCI Mutually exclusive procedures 33503 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 64416 NCCI Misuse of Column 2 code with Column 1 code 33503 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33503 90780 NCCI NCCI Standards of medical / surgical practice 33503 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33503 92995 NCCI NCCI Most extensive procedures 33503 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33504 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33504 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33504 32100 NCCI NCCI Standards of medical / surgical practice 33504 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33504 33141 NCCI NCCI Standards of medical / surgical practice 33504 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33504 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33504 33503 NCCI NCCI "With" versus "without" procedures 33504 33504 BCBST 33504 33505 NCCI NCCI Mutually exclusive procedures 33504 33506 NCCI NCCI Mutually exclusive procedures 33504 35226 NCCI NCCI Standards of medical / surgical practice CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 229 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33504 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 64416 NCCI Misuse of Column 2 code with Column 1 code 33504 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33504 90780 NCCI NCCI Standards of medical / surgical practice 33504 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33504 92995 NCCI NCCI Most extensive procedures 33504 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33505 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33505 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33505 32100 NCCI NCCI Standards of medical / surgical practice 33505 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33505 33141 NCCI NCCI Standards of medical / surgical practice 33505 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33505 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33505 33310 BCBST NCCI Refer to Specific Guidelines 33505 33315 BCBST NCCI Refer to Specific Guidelines 33505 33505 BCBST Code redundant to self/should not be reported more than once due to standard description 33505 33506 NCCI NCCI Mutually exclusive procedures 33505 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 64416 NCCI Misuse of Column 2 code with Column 1 code 33505 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33505 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 230 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33505 92995 NCCI NCCI Most extensive procedures 33505 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33506 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33506 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33506 32100 NCCI NCCI Standards of medical / surgical practice 33506 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33506 33141 NCCI NCCI Standards of medical / surgical practice 33506 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33506 33310 BCBST NCCI Refer to Specific Guidelines 33506 33315 BCBST NCCI Refer to Specific Guidelines 33506 33506 BCBST Code redundant to self/should not be reported more than once due to standard description 33506 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 64416 NCCI Misuse of Column 2 code with Column 1 code 33506 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33506 90780 NCCI NCCI Standards of medical / surgical practice 33506 92982 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33506 92995 NCCI NCCI Most extensive procedures 33506 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33508 33508 BCBST This procedure can only be performed once on a patient, or is typically only performed more than once in unusual circumstances. 33508 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 231 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33508 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. 33508 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. 33508 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. 33508 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. 33508 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. 33508 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. 33508 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 232 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33508 90780 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. 33508 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33510 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33510 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33510 32100 NCCI NCCI Standards of medical / surgical practice 33510 32120 NCCI NCCI Standards of medical / surgical practice 33510 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33510 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33510 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33510 33310 BCBST 33510 33315 NCCI 33510 33510 BCBST 33510 35226 NCCI NCCI Standards of medical / surgical practice 33510 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33510 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33510 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33510 35761 NCCI NCCI Standards of medical / surgical practice 33510 35820 NCCI NCCI Standards of medical / surgical practice 33510 36010 NCCI NCCI Standards of medical / surgical practice 33510 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 37616 NCCI NCCI Standards of medical / surgical practice 33510 37700 NCCI NCCI Standards of medical / surgical practice 33510 37720 NCCI NCCI Standards of medical / surgical practice 33510 37730 NCCI NCCI Standards of medical / surgical practice 33510 37735 NCCI NCCI Standards of medical / surgical practice 33510 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 64416 NCCI Misuse of Column 2 code with Column 1 code 33510 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33510 76880 NCCI Misuse of Column 2 code with Column 1 code 33510 76986 NCCI Standards of medical / surgical practice CPT TM NCCI Refer to Specific Guidelines NCCI Standards of medical / surgical practice Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 233 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33510 90780 NCCI NCCI Standards of medical / surgical practice 33510 92953 NCCI NCCI Standards of medical / surgical practice 33510 92970 NCCI NCCI Standards of medical / surgical practice 33510 92971 NCCI NCCI Standards of medical / surgical practice 33510 93307 NCCI NCCI Standards of medical / surgical practice 33510 93501 NCCI NCCI Standards of medical / surgical practice 33510 93965 NCCI Misuse of Column 2 code with Column 1 code 33510 93970 NCCI Misuse of Column 2 code with Column 1 code 33510 94656 NCCI NCCI Standards of medical / surgical practice 33510 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33510 S2207 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. 33511 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33511 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33511 32100 NCCI NCCI Standards of medical / surgical practice 33511 32120 NCCI NCCI Standards of medical / surgical practice 33511 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33511 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33511 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33511 33310 BCBST 33511 33315 NCCI NCCI Standards of medical / surgical practice 33511 33510 NCCI NCCI Most extensive procedures 33511 33511 BCBST 33511 35226 NCCI NCCI Standards of medical / surgical practice 33511 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33511 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33511 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33511 35820 NCCI NCCI Standards of medical / surgical practice 33511 36010 NCCI NCCI Standards of medical / surgical practice 33511 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 37616 NCCI NCCI Standards of medical / surgical practice 33511 37700 NCCI NCCI Standards of medical / surgical practice 33511 37720 NCCI NCCI Standards of medical / surgical practice 33511 37730 NCCI NCCI Standards of medical / surgical practice 33511 37735 NCCI NCCI Standards of medical / surgical practice 33511 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Refer to Specific Guidelines Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 234 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33511 64416 NCCI Misuse of Column 2 code with Column 1 code 33511 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33511 76880 NCCI Misuse of Column 2 code with Column 1 code 33511 76986 NCCI Standards of medical / surgical practice 33511 90780 NCCI NCCI Standards of medical / surgical practice 33511 92953 NCCI NCCI Standards of medical / surgical practice 33511 92970 NCCI NCCI Standards of medical / surgical practice 33511 92971 NCCI NCCI Standards of medical / surgical practice 33511 93307 NCCI NCCI Standards of medical / surgical practice 33511 93501 NCCI NCCI Standards of medical / surgical practice 33511 93965 NCCI Misuse of Column 2 code with Column 1 code 33511 93970 NCCI Misuse of Column 2 code with Column 1 code 33511 94656 NCCI NCCI Standards of medical / surgical practice 33511 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33512 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33512 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33512 32100 NCCI NCCI Standards of medical / surgical practice 33512 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33512 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33512 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33512 33310 BCBST NCCI Refer to Specific Guidelines 33512 33315 BCBST NCCI Refer to Specific Guidelines 33512 33510 NCCI NCCI Most extensive procedures 33512 33511 NCCI NCCI Most extensive procedures 33512 33512 BCBST 33512 35226 NCCI NCCI Standards of medical / surgical practice 33512 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33512 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33512 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33512 35761 NCCI NCCI Standards of medical / surgical practice 33512 35820 NCCI NCCI Standards of medical / surgical practice 33512 36010 NCCI NCCI Standards of medical / surgical practice 33512 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 37616 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 235 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33512 37700 NCCI NCCI Standards of medical / surgical practice 33512 37720 NCCI NCCI Standards of medical / surgical practice 33512 37730 NCCI NCCI Standards of medical / surgical practice 33512 37735 NCCI NCCI Standards of medical / surgical practice 33512 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 64416 NCCI Misuse of Column 2 code with Column 1 code 33512 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33512 76880 NCCI Misuse of Column 2 code with Column 1 code 33512 76986 NCCI Standards of medical / surgical practice 33512 90780 NCCI NCCI Standards of medical / surgical practice 33512 92953 NCCI NCCI Standards of medical / surgical practice 33512 92970 NCCI NCCI Standards of medical / surgical practice 33512 92971 NCCI NCCI Standards of medical / surgical practice 33512 93501 NCCI NCCI Standards of medical / surgical practice 33512 93965 NCCI Misuse of Column 2 code with Column 1 code 33512 93970 NCCI Misuse of Column 2 code with Column 1 code 33512 94656 NCCI NCCI Standards of medical / surgical practice 33512 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33513 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33513 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33513 32100 NCCI NCCI Standards of medical / surgical practice 33513 32120 NCCI NCCI Standards of medical / surgical practice 33513 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33513 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33513 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33513 33310 BCBST 33513 33315 NCCI NCCI Standards of medical / surgical practice 33513 33510 NCCI NCCI Most extensive procedures 33513 33511 NCCI NCCI Most extensive procedures 33513 33512 NCCI NCCI Most extensive procedures 33513 33513 BCBST CPT TM NCCI Refer to Specific Guidelines Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 236 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33513 35226 NCCI NCCI Standards of medical / surgical practice 33513 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33513 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33513 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33513 35761 NCCI NCCI Standards of medical / surgical practice 33513 35820 NCCI NCCI Standards of medical / surgical practice 33513 36010 NCCI NCCI Standards of medical / surgical practice 33513 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 37700 NCCI NCCI Standards of medical / surgical practice 33513 37720 NCCI NCCI Standards of medical / surgical practice 33513 37730 NCCI NCCI Standards of medical / surgical practice 33513 37735 NCCI NCCI Standards of medical / surgical practice 33513 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 64416 NCCI Misuse of Column 2 code with Column 1 code 33513 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33513 76880 NCCI Misuse of Column 2 code with Column 1 code 33513 76986 NCCI Standards of medical / surgical practice 33513 90780 NCCI NCCI Standards of medical / surgical practice 33513 92953 NCCI NCCI Standards of medical / surgical practice 33513 92970 NCCI NCCI Standards of medical / surgical practice 33513 92971 NCCI NCCI Standards of medical / surgical practice 33513 93307 NCCI NCCI Standards of medical / surgical practice 33513 93501 NCCI NCCI Standards of medical / surgical practice 33513 93965 NCCI Misuse of Column 2 code with Column 1 code 33513 93970 NCCI Misuse of Column 2 code with Column 1 code 33513 94656 NCCI NCCI Standards of medical / surgical practice 33513 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33514 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33514 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33514 32100 NCCI NCCI Standards of medical / surgical practice 33514 32120 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 237 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33514 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33514 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33514 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33514 33310 BCBST 33514 33315 NCCI NCCI Standards of medical / surgical practice 33514 33510 NCCI NCCI Most extensive procedures 33514 33511 NCCI NCCI Most extensive procedures 33514 33512 NCCI NCCI Most extensive procedures 33514 33513 NCCI NCCI Most extensive procedures 33514 33514 BCBST 33514 35226 NCCI NCCI Standards of medical / surgical practice 33514 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33514 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33514 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33514 35761 NCCI NCCI Standards of medical / surgical practice 33514 35820 NCCI NCCI Standards of medical / surgical practice 33514 36010 NCCI NCCI Standards of medical / surgical practice 33514 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 37616 NCCI NCCI Standards of medical / surgical practice 33514 37700 NCCI NCCI Standards of medical / surgical practice 33514 37720 NCCI NCCI Standards of medical / surgical practice 33514 37730 NCCI NCCI Standards of medical / surgical practice 33514 37735 NCCI NCCI Standards of medical / surgical practice 33514 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 64416 NCCI Misuse of Column 2 code with Column 1 code 33514 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33514 76880 NCCI Misuse of Column 2 code with Column 1 code 33514 76986 NCCI Standards of medical / surgical practice 33514 90780 NCCI NCCI Standards of medical / surgical practice 33514 92953 NCCI NCCI Standards of medical / surgical practice 33514 92970 NCCI NCCI Standards of medical / surgical practice 33514 92971 NCCI NCCI Standards of medical / surgical practice CPT TM NCCI Refer to Specific Guidelines Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 238 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33514 93307 NCCI NCCI Standards of medical / surgical practice 33514 93501 NCCI NCCI Standards of medical / surgical practice 33514 93965 NCCI Misuse of Column 2 code with Column 1 code 33514 93970 NCCI Misuse of Column 2 code with Column 1 code 33514 94656 NCCI NCCI Standards of medical / surgical practice 33514 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33516 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33516 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33516 32100 NCCI NCCI Standards of medical / surgical practice 33516 32120 NCCI NCCI Standards of medical / surgical practice 33516 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33516 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33516 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33516 33310 BCBST 33516 33315 NCCI NCCI Standards of medical / surgical practice 33516 33510 NCCI NCCI Most extensive procedures 33516 33511 NCCI NCCI Most extensive procedures 33516 33512 NCCI NCCI Most extensive procedures 33516 33513 NCCI NCCI Most extensive procedures 33516 33514 NCCI NCCI Most extensive procedures 33516 33516 BCBST 33516 35226 NCCI NCCI Standards of medical / surgical practice 33516 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33516 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33516 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33516 35761 NCCI NCCI Standards of medical / surgical practice 33516 35820 NCCI NCCI Standards of medical / surgical practice 33516 36010 NCCI NCCI Standards of medical / surgical practice 33516 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 37616 NCCI NCCI Standards of medical / surgical practice 33516 37700 NCCI NCCI Standards of medical / surgical practice 33516 37720 NCCI NCCI Standards of medical / surgical practice 33516 37730 NCCI NCCI Standards of medical / surgical practice 33516 37735 NCCI NCCI Standards of medical / surgical practice 33516 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Refer to Specific Guidelines Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 239 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33516 64416 NCCI Misuse of Column 2 code with Column 1 code 33516 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33516 76880 NCCI Misuse of Column 2 code with Column 1 code 33516 76986 NCCI Standards of medical / surgical practice 33516 90780 NCCI NCCI Standards of medical / surgical practice 33516 92953 NCCI NCCI Standards of medical / surgical practice 33516 92970 NCCI NCCI Standards of medical / surgical practice 33516 92971 NCCI NCCI Standards of medical / surgical practice 33516 93307 NCCI NCCI Standards of medical / surgical practice 33516 93501 NCCI NCCI Standards of medical / surgical practice 33516 93965 NCCI Misuse of Column 2 code with Column 1 code 33516 93970 NCCI Misuse of Column 2 code with Column 1 code 33516 94656 NCCI NCCI Standards of medical / surgical practice 33516 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33517 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33517 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33517 32100 NCCI NCCI Standards of medical / surgical practice 33517 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33517 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33517 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33517 33310 BCBST NCCI Refer to Specific Guidelines 33517 33315 BCBST NCCI Refer to Specific Guidelines 33517 33517 BCBST Procedure redundant to itself. 33517 35226 NCCI NCCI Standards of medical / surgical practice 33517 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33517 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33517 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33517 35820 NCCI NCCI Standards of medical / surgical practice 33517 37700 NCCI NCCI Standards of medical / surgical practice 33517 37720 NCCI NCCI Standards of medical / surgical practice 33517 37730 NCCI NCCI Standards of medical / surgical practice 33517 37735 NCCI NCCI Standards of medical / surgical practice 33517 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33517 76880 NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 240 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33517 76986 NCCI Standards of medical / surgical practice 33517 92953 NCCI NCCI Standards of medical / surgical practice 33517 92970 NCCI NCCI Standards of medical / surgical practice 33517 92971 NCCI NCCI Standards of medical / surgical practice 33517 93965 NCCI Misuse of Column 2 code with Column 1 code 33517 93970 NCCI Misuse of Column 2 code with Column 1 code 33517 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33517 S2208 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. 33517 S2209 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. 33518 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33518 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33518 32100 NCCI NCCI Standards of medical / surgical practice 33518 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33518 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33518 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33518 33310 BCBST NCCI Refer to Specific Guidelines 33518 33315 BCBST NCCI Refer to Specific Guidelines 33518 33517 NCCI NCCI Most extensive procedures 33518 33518 BCBST 33518 35226 NCCI NCCI Standards of medical / surgical practice 33518 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33518 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33518 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33518 35820 NCCI NCCI Standards of medical / surgical practice 33518 37700 NCCI NCCI Standards of medical / surgical practice 33518 37720 NCCI NCCI Standards of medical / surgical practice 33518 37730 NCCI NCCI Standards of medical / surgical practice 33518 37735 NCCI NCCI Standards of medical / surgical practice 33518 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33518 76880 NCCI Misuse of Column 2 code with Column 1 code 33518 76986 NCCI Standards of medical / surgical practice 33518 92953 NCCI NCCI Standards of medical / surgical practice 33518 92970 NCCI NCCI Standards of medical / surgical practice 33518 92971 NCCI NCCI Standards of medical / surgical practice 33518 93965 NCCI Misuse of Column 2 code with Column 1 code 33518 93970 NCCI Misuse of Column 2 code with Column 1 code 33518 S0020 CPT CMS 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 TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 241 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33519 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33519 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33519 32100 NCCI NCCI Standards of medical / surgical practice 33519 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33519 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33519 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33519 33310 BCBST NCCI Refer to Specific Guidelines 33519 33315 BCBST NCCI Refer to Specific Guidelines 33519 33517 NCCI NCCI Most extensive procedures 33519 33518 NCCI NCCI Most extensive procedures 33519 33519 BCBST 33519 35226 NCCI NCCI Standards of medical / surgical practice 33519 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33519 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33519 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33519 35820 NCCI NCCI Standards of medical / surgical practice 33519 37700 NCCI NCCI Standards of medical / surgical practice 33519 37720 NCCI NCCI Standards of medical / surgical practice 33519 37730 NCCI NCCI Standards of medical / surgical practice 33519 37735 NCCI NCCI Standards of medical / surgical practice 33519 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33519 76880 NCCI Misuse of Column 2 code with Column 1 code 33519 76986 NCCI Standards of medical / surgical practice 33519 92953 NCCI NCCI Standards of medical / surgical practice 33519 92970 NCCI NCCI Standards of medical / surgical practice 33519 92971 NCCI NCCI Standards of medical / surgical practice 33519 93965 NCCI Misuse of Column 2 code with Column 1 code 33519 93970 NCCI Misuse of Column 2 code with Column 1 code 33519 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33521 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33521 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33521 32100 NCCI NCCI Standards of medical / surgical practice 33521 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33521 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33521 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33521 33310 BCBST NCCI Refer to Specific Guidelines 33521 33315 BCBST NCCI Refer to Specific Guidelines 33521 33517 NCCI NCCI Most extensive procedures CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 242 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33521 33518 33521 33521 Source Rationale NCCI NCCI Most extensive procedures 33519 NCCI NCCI Most extensive procedures 33521 BCBST 33521 35226 NCCI NCCI Standards of medical / surgical practice 33521 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33521 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33521 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33521 35820 NCCI NCCI Standards of medical / surgical practice 33521 37700 NCCI NCCI Standards of medical / surgical practice 33521 37720 NCCI NCCI Standards of medical / surgical practice 33521 37730 NCCI NCCI Standards of medical / surgical practice 33521 37735 NCCI NCCI Standards of medical / surgical practice 33521 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33521 76880 NCCI Misuse of Column 2 code with Column 1 code 33521 76986 NCCI Standards of medical / surgical practice 33521 92953 NCCI NCCI Standards of medical / surgical practice 33521 92970 NCCI NCCI Standards of medical / surgical practice 33521 92971 NCCI NCCI Standards of medical / surgical practice 33521 93965 NCCI Misuse of Column 2 code with Column 1 code 33521 93970 NCCI Misuse of Column 2 code with Column 1 code 33521 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33522 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33522 32100 NCCI NCCI Standards of medical / surgical practice 33522 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33522 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33522 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33522 33310 BCBST NCCI Refer to Specific Guidelines 33522 33315 BCBST NCCI Refer to Specific Guidelines 33522 33517 NCCI NCCI Most extensive procedures 33522 33518 NCCI NCCI Most extensive procedures 33522 33519 NCCI NCCI Most extensive procedures 33522 33521 NCCI NCCI Most extensive procedures 33522 33522 BCBST 33522 35226 NCCI NCCI Standards of medical / surgical practice 33522 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33522 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33522 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33522 35820 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 243 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33522 37700 NCCI NCCI Standards of medical / surgical practice 33522 37720 NCCI NCCI Standards of medical / surgical practice 33522 37730 NCCI NCCI Standards of medical / surgical practice 33522 37735 NCCI NCCI Standards of medical / surgical practice 33522 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33522 76880 NCCI Misuse of Column 2 code with Column 1 code 33522 76986 NCCI Standards of medical / surgical practice 33522 92953 NCCI NCCI Standards of medical / surgical practice 33522 92970 NCCI NCCI Standards of medical / surgical practice 33522 92971 NCCI NCCI Standards of medical / surgical practice 33522 93965 NCCI Misuse of Column 2 code with Column 1 code 33522 93970 NCCI Misuse of Column 2 code with Column 1 code 33522 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33523 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33523 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33523 32100 NCCI NCCI Standards of medical / surgical practice 33523 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33523 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33523 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33523 33310 BCBST NCCI Refer to Specific Guidelines 33523 33315 BCBST NCCI Refer to Specific Guidelines 33523 33517 NCCI NCCI Most extensive procedures 33523 33518 BCBST NCCI Refer to Specific Guidelines 33523 33518 NCCI NCCI Most extensive procedures 33523 33519 NCCI NCCI Most extensive procedures 33523 33521 NCCI NCCI Most extensive procedures 33523 33522 NCCI NCCI Most extensive procedures 33523 33523 BCBST 33523 35226 NCCI NCCI Standards of medical / surgical practice 33523 35681 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33523 35682 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33523 35683 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33523 35820 NCCI NCCI Standards of medical / surgical practice 33523 37700 NCCI NCCI Standards of medical / surgical practice 33523 37720 NCCI NCCI Standards of medical / surgical practice 33523 37730 NCCI NCCI Standards of medical / surgical practice 33523 37735 NCCI NCCI Standards of medical / surgical practice 33523 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 244 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33523 76880 NCCI Misuse of Column 2 code with Column 1 code 33523 76986 NCCI Standards of medical / surgical practice 33523 92953 NCCI NCCI Standards of medical / surgical practice 33523 92970 NCCI NCCI Standards of medical / surgical practice 33523 92971 NCCI NCCI Standards of medical / surgical practice 33523 93965 NCCI Misuse of Column 2 code with Column 1 code 33523 93970 NCCI Misuse of Column 2 code with Column 1 code 33523 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33530 33310 BCBST NCCI Refer to Specific Guidelines 33530 33315 BCBST NCCI Refer to Specific Guidelines 33530 33530 BCBST Procedure redundant to itself. 33530 35226 NCCI NCCI Standards of medical / surgical practice 33530 35820 NCCI NCCI Standards of medical / surgical practice 33530 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33533 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33533 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33533 32100 NCCI NCCI Standards of medical / surgical practice 33533 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33533 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33533 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33533 33310 BCBST NCCI Refer to Specific Guidelines 33533 33315 BCBST NCCI Refer to Specific Guidelines 33533 33533 BCBST Procedure redundant to itself. 33533 35226 NCCI NCCI Standards of medical / surgical practice 33533 35820 NCCI NCCI Standards of medical / surgical practice 33533 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 64416 NCCI Misuse of Column 2 code with Column 1 code 33533 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33533 90780 NCCI NCCI Standards of medical / surgical practice 33533 92953 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 245 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33533 Source Rationale 92970 NCCI 33533 92971 NCCI NCCI Standards of medical / surgical practice 33533 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33533 S2205 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. 33534 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33534 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33534 32100 NCCI NCCI Standards of medical / surgical practice 33534 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33534 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33534 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33534 33310 BCBST NCCI Refer to Specific Guidelines 33534 33315 BCBST NCCI Refer to Specific Guidelines 33534 33533 NCCI NCCI Most extensive procedures 33534 33534 BCBST 33534 35226 NCCI NCCI Standards of medical / surgical practice 33534 35820 NCCI NCCI Standards of medical / surgical practice 33534 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 64416 NCCI Misuse of Column 2 code with Column 1 code 33534 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33534 90780 NCCI NCCI Standards of medical / surgical practice 33534 92953 NCCI NCCI Standards of medical / surgical practice 33534 92970 NCCI NCCI Standards of medical / surgical practice 33534 92971 NCCI NCCI Standards of medical / surgical practice 33534 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33534 S2206 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. 33535 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33535 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33535 32100 NCCI NCCI Standards of medical / surgical practice 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33535 CPT TM NCCI Standards of medical / surgical practice Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 246 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33535 33210 33535 33535 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33310 BCBST NCCI Refer to Specific Guidelines 33535 33315 BCBST NCCI Refer to Specific Guidelines 33535 33533 NCCI NCCI Most extensive procedures 33535 33534 NCCI NCCI Most extensive procedures 33535 33535 BCBST 33535 35226 NCCI NCCI Standards of medical / surgical practice 33535 35820 NCCI NCCI Standards of medical / surgical practice 33535 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 64416 NCCI Misuse of Column 2 code with Column 1 code 33535 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33535 90780 NCCI NCCI Standards of medical / surgical practice 33535 92953 NCCI NCCI Standards of medical / surgical practice 33535 92970 NCCI NCCI Standards of medical / surgical practice 33535 92971 NCCI NCCI Standards of medical / surgical practice 33535 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33536 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33536 32020 NCCI NCCI Standards of medical / surgical practice 33536 32100 NCCI NCCI Standards of medical / surgical practice 33536 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33536 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33536 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33536 33310 BCBST NCCI Refer to Specific Guidelines 33536 33315 BCBST NCCI Refer to Specific Guidelines 33536 33533 NCCI NCCI Most extensive procedures 33536 33534 NCCI NCCI Most extensive procedures 33536 33535 NCCI NCCI Most extensive procedures 33536 33536 BCBST 33536 35226 NCCI CPT TM Procedure redundant to itself. Procedure redundant to itself. NCCI Standards of medical / surgical practice is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 247 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33536 35820 NCCI NCCI Standards of medical / surgical practice 33536 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 64416 NCCI Misuse of Column 2 code with Column 1 code 33536 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33536 90780 NCCI NCCI Standards of medical / surgical practice 33536 92953 NCCI NCCI Standards of medical / surgical practice 33536 92970 NCCI NCCI Standards of medical / surgical practice 33536 92971 NCCI NCCI Standards of medical / surgical practice 33536 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33542 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33542 32020 NCCI NCCI Standards of medical / surgical practice 33542 32100 NCCI NCCI Standards of medical / surgical practice 33542 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33542 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33542 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33542 33542 BCBST 33542 35226 NCCI NCCI Standards of medical / surgical practice 33542 35820 NCCI NCCI Standards of medical / surgical practice 33542 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 64416 NCCI Misuse of Column 2 code with Column 1 code 33542 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33542 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 248 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33542 92953 NCCI NCCI Standards of medical / surgical practice 33542 92970 NCCI NCCI Standards of medical / surgical practice 33542 92971 NCCI NCCI Standards of medical / surgical practice 33542 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33545 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33545 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33545 32100 NCCI NCCI Standards of medical / surgical practice 33545 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33545 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33545 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33545 33542 NCCI NCCI HCPCS/CPT procedure code definition 33545 33545 BCBST 33545 35226 NCCI NCCI Standards of medical / surgical practice 33545 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 64416 NCCI Misuse of Column 2 code with Column 1 code 33545 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33545 90780 NCCI NCCI Standards of medical / surgical practice 33545 92953 NCCI NCCI Standards of medical / surgical practice 33545 92970 NCCI NCCI Standards of medical / surgical practice 33545 92971 NCCI NCCI Standards of medical / surgical practice 33545 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33572 33310 BCBST NCCI Refer to Specific Guidelines 33572 33315 BCBST NCCI Refer to Specific Guidelines 33572 35226 NCCI NCCI Standards of medical / surgical practice 33572 35820 NCCI NCCI Standards of medical / surgical practice 33572 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33600 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33600 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33600 33140 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 249 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33600 33141 NCCI NCCI Standards of medical / surgical practice 33600 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33600 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33600 33310 BCBST NCCI Refer to Specific Guidelines 33600 33315 BCBST NCCI Refer to Specific Guidelines 33600 33427 NCCI NCCI Mutually exclusive procedures 33600 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33600 33600 BCBST 33600 35226 NCCI NCCI Standards of medical / surgical practice 33600 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 64416 NCCI Misuse of Column 2 code with Column 1 code 33600 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33600 90780 NCCI NCCI Standards of medical / surgical practice 33600 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33602 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33602 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33602 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33602 33141 NCCI NCCI Standards of medical / surgical practice 33602 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33602 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33602 33310 BCBST NCCI Refer to Specific Guidelines 33602 33315 BCBST NCCI Refer to Specific Guidelines 33602 33411 NCCI NCCI Mutually exclusive procedures 33602 33412 NCCI NCCI Mutually exclusive procedures 33602 33413 NCCI NCCI Mutually exclusive procedures 33602 33414 NCCI NCCI Mutually exclusive procedures 33602 33416 NCCI NCCI Mutually exclusive procedures 33602 33417 NCCI NCCI Mutually exclusive procedures 33602 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 250 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33602 33602 BCBST Code redundant to self/should not be reported more than once due to standard description 33602 35226 NCCI NCCI Standards of medical / surgical practice 33602 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 64416 NCCI Misuse of Column 2 code with Column 1 code 33602 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33602 90780 NCCI NCCI Standards of medical / surgical practice 33602 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33606 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33606 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33606 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33606 33141 NCCI NCCI Standards of medical / surgical practice 33606 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33606 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33606 33310 BCBST NCCI Refer to Specific Guidelines 33606 33315 BCBST NCCI Refer to Specific Guidelines 33606 33606 BCBST Code redundant to self/should not be reported more than once due to standard description 33606 35226 NCCI NCCI Standards of medical / surgical practice 33606 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 64416 NCCI Misuse of Column 2 code with Column 1 code 33606 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33606 90780 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 251 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33606 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33608 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33608 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33608 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33608 33141 NCCI NCCI Standards of medical / surgical practice 33608 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33608 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33608 33310 BCBST NCCI Refer to Specific Guidelines 33608 33315 BCBST NCCI Refer to Specific Guidelines 33608 33608 BCBST Code redundant to self/should not be reported more than once due to standard description 33608 35226 NCCI NCCI Standards of medical / surgical practice 33608 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 64416 NCCI Misuse of Column 2 code with Column 1 code 33608 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33608 90780 NCCI NCCI Standards of medical / surgical practice 33608 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33610 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33610 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33610 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33610 33141 NCCI NCCI Standards of medical / surgical practice 33610 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33610 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33610 33310 BCBST NCCI Refer to Specific Guidelines 33610 33315 BCBST NCCI Refer to Specific Guidelines 33610 33610 BCBST Code redundant to self/should not be reported more than once due to standard description 33610 35226 NCCI NCCI Standards of medical / surgical practice 33610 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 252 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33610 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 64416 NCCI Misuse of Column 2 code with Column 1 code 33610 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33610 90780 NCCI NCCI Standards of medical / surgical practice 33610 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33611 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33611 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33611 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33611 33141 NCCI NCCI Standards of medical / surgical practice 33611 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33611 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33611 33310 BCBST NCCI Refer to Specific Guidelines 33611 33315 BCBST NCCI Refer to Specific Guidelines 33611 33611 BCBST Code redundant to self/should not be reported more than once due to standard description 33611 35226 NCCI NCCI Standards of medical / surgical practice 33611 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 64416 NCCI Misuse of Column 2 code with Column 1 code 33611 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33611 90780 NCCI NCCI Standards of medical / surgical practice 33611 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33612 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33612 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33612 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33612 33141 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 253 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33612 33210 33612 33612 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33310 BCBST NCCI Refer to Specific Guidelines 33612 33315 BCBST NCCI Refer to Specific Guidelines 33612 33611 NCCI 33612 33612 BCBST 33612 35226 NCCI NCCI Standards of medical / surgical practice 33612 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 64416 NCCI Misuse of Column 2 code with Column 1 code 33612 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33612 90780 NCCI NCCI Standards of medical / surgical practice 33612 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33615 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33615 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33615 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33615 33141 NCCI NCCI Standards of medical / surgical practice 33615 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33615 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33615 33310 BCBST NCCI Refer to Specific Guidelines 33615 33315 BCBST NCCI Refer to Specific Guidelines 33615 33615 BCBST Code redundant to self/should not be reported more than once due to standard description 33615 35226 NCCI NCCI Standards of medical / surgical practice 33615 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 64416 NCCI Misuse of Column 2 code with Column 1 code 33615 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 254 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33615 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33615 90780 NCCI NCCI Standards of medical / surgical practice 33615 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33617 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33617 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33617 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33617 33141 NCCI NCCI Standards of medical / surgical practice 33617 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33617 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33617 33310 BCBST NCCI Refer to Specific Guidelines 33617 33315 BCBST NCCI Refer to Specific Guidelines 33617 33617 BCBST Code redundant to self/should not be reported more than once due to standard description 33617 35226 NCCI NCCI Standards of medical / surgical practice 33617 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 64416 NCCI Misuse of Column 2 code with Column 1 code 33617 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33617 90780 NCCI NCCI Standards of medical / surgical practice 33617 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33619 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33619 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33619 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33619 33141 NCCI NCCI Standards of medical / surgical practice 33619 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33619 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33619 33310 BCBST NCCI Refer to Specific Guidelines 33619 33315 BCBST NCCI Refer to Specific Guidelines CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 255 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33619 33619 BCBST Code redundant to self/should not be reported more than once due to standard description 33619 35226 NCCI NCCI Standards of medical / surgical practice 33619 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 64416 NCCI Misuse of Column 2 code with Column 1 code 33619 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33619 90780 NCCI NCCI Standards of medical / surgical practice 33619 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33641 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33641 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33641 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33641 33141 NCCI NCCI Standards of medical / surgical practice 33641 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33641 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33641 33641 BCBST 33641 33647 NCCI NCCI Mutually exclusive procedures 33641 33660 NCCI NCCI Mutually exclusive procedures 33641 35226 NCCI NCCI Standards of medical / surgical practice 33641 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 64416 NCCI Misuse of Column 2 code with Column 1 code 33641 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33641 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 256 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33641 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33645 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33645 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33645 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33645 33141 NCCI NCCI Standards of medical / surgical practice 33645 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33645 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33645 33645 BCBST 33645 35226 NCCI NCCI Standards of medical / surgical practice 33645 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 64416 NCCI Misuse of Column 2 code with Column 1 code 33645 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33645 90780 NCCI NCCI Standards of medical / surgical practice 33645 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33647 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33647 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33647 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33647 33141 NCCI NCCI Standards of medical / surgical practice 33647 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33647 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33647 33647 BCBST 33647 33681 NCCI NCCI HCPCS/CPT procedure code definition 33647 35226 NCCI NCCI Standards of medical / surgical practice 33647 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 64416 NCCI Misuse of Column 2 code with Column 1 code 33647 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 257 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33647 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33647 90780 NCCI NCCI Standards of medical / surgical practice 33647 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33660 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33660 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33660 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33660 33141 NCCI NCCI Standards of medical / surgical practice 33660 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33660 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33660 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33660 33647 NCCI NCCI Mutually exclusive procedures 33660 33660 BCBST 33660 33665 NCCI NCCI Mutually exclusive procedures 33660 33670 NCCI NCCI Mutually exclusive procedures 33660 35226 NCCI NCCI Standards of medical / surgical practice 33660 35820 NCCI NCCI Standards of medical / surgical practice 33660 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 64416 NCCI Misuse of Column 2 code with Column 1 code 33660 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33660 90780 NCCI NCCI Standards of medical / surgical practice 33660 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33665 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33665 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33665 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33665 33141 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 258 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33665 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33665 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33665 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33665 33647 NCCI NCCI Mutually exclusive procedures 33665 33665 BCBST 33665 35226 NCCI NCCI Standards of medical / surgical practice 33665 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 64416 NCCI Misuse of Column 2 code with Column 1 code 33665 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33665 90780 NCCI NCCI Standards of medical / surgical practice 33665 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33670 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33670 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33670 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33670 33141 NCCI NCCI Standards of medical / surgical practice 33670 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33670 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33670 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33670 33670 BCBST 33670 35226 NCCI NCCI Standards of medical / surgical practice 33670 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 64416 NCCI Misuse of Column 2 code with Column 1 code 33670 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 259 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33670 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33670 90780 NCCI NCCI Standards of medical / surgical practice 33670 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33681 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33681 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33681 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33681 33141 NCCI NCCI Standards of medical / surgical practice 33681 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33681 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33681 33681 BCBST 33681 35226 NCCI NCCI Standards of medical / surgical practice 33681 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 64416 NCCI Misuse of Column 2 code with Column 1 code 33681 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33681 90780 NCCI NCCI Standards of medical / surgical practice 33681 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33684 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33684 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33684 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33684 33141 NCCI NCCI Standards of medical / surgical practice 33684 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33684 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33684 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33684 33681 NCCI NCCI HCPCS/CPT procedure code definition 33684 33684 BCBST 33684 35226 NCCI NCCI Standards of medical / surgical practice 33684 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 260 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33684 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 64416 NCCI Misuse of Column 2 code with Column 1 code 33684 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33684 90780 NCCI NCCI Standards of medical / surgical practice 33684 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33688 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33688 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33688 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33688 33141 NCCI NCCI Standards of medical / surgical practice 33688 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33688 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33688 33681 NCCI NCCI HCPCS/CPT procedure code definition 33688 33688 BCBST 33688 35226 NCCI NCCI Standards of medical / surgical practice 33688 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 64416 NCCI Misuse of Column 2 code with Column 1 code 33688 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33688 90780 NCCI NCCI Standards of medical / surgical practice 33688 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33690 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33690 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33690 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33690 33141 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 261 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33690 33210 33690 33690 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33690 BCBST 33690 35226 NCCI NCCI Standards of medical / surgical practice 33690 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 64416 NCCI Misuse of Column 2 code with Column 1 code 33690 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33690 90780 NCCI NCCI Standards of medical / surgical practice 33690 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33692 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33692 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33692 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33692 33141 NCCI NCCI Standards of medical / surgical practice 33692 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33692 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33692 33692 BCBST 33692 35226 NCCI NCCI Standards of medical / surgical practice 33692 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 64416 NCCI Misuse of Column 2 code with Column 1 code 33692 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33692 90780 NCCI NCCI Standards of medical / surgical practice CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 262 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33692 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33694 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33694 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33694 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33694 33141 NCCI NCCI Standards of medical / surgical practice 33694 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33694 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33694 33692 NCCI NCCI HCPCS/CPT procedure code definition 33694 33694 BCBST 33694 33697 NCCI NCCI Mutually exclusive procedures 33694 35226 NCCI NCCI Standards of medical / surgical practice 33694 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 64416 NCCI Misuse of Column 2 code with Column 1 code 33694 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33694 90780 NCCI NCCI Standards of medical / surgical practice 33694 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33697 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33697 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33697 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33697 33141 NCCI NCCI Standards of medical / surgical practice 33697 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33697 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33697 33310 BCBST NCCI Refer to Specific Guidelines 33697 33315 BCBST NCCI Refer to Specific Guidelines 33697 33692 NCCI 33697 33697 BCBST 33697 35226 NCCI NCCI Standards of medical / surgical practice 33697 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 CPT TM Code redundant to self/should not be reported more than once due to standard description NCCI "With" versus "without" procedures Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 263 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33697 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 64416 NCCI Misuse of Column 2 code with Column 1 code 33697 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33697 90780 NCCI NCCI Standards of medical / surgical practice 33697 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33702 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33702 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33702 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33702 33141 NCCI NCCI Standards of medical / surgical practice 33702 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33702 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33702 33702 BCBST 33702 35226 NCCI NCCI Standards of medical / surgical practice 33702 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 64416 NCCI Misuse of Column 2 code with Column 1 code 33702 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33702 90780 NCCI NCCI Standards of medical / surgical practice 33702 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33710 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33710 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33710 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33710 33141 NCCI NCCI Standards of medical / surgical practice 33710 33210 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 264 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33710 33211 33710 33710 Source Rationale NCCI NCCI HCPCS/CPT separate procedure definition 33702 NCCI NCCI HCPCS/CPT procedure code definition 33710 BCBST 33710 35226 NCCI NCCI Standards of medical / surgical practice 33710 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 64416 NCCI Misuse of Column 2 code with Column 1 code 33710 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33710 90780 NCCI NCCI Standards of medical / surgical practice 33710 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33720 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33720 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33720 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33720 33141 NCCI NCCI Standards of medical / surgical practice 33720 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33720 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33720 33720 BCBST 33720 35226 NCCI NCCI Standards of medical / surgical practice 33720 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 64416 NCCI Misuse of Column 2 code with Column 1 code 33720 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33720 90780 NCCI NCCI Standards of medical / surgical practice CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 265 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33720 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33722 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33722 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33722 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33722 33141 NCCI NCCI Standards of medical / surgical practice 33722 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33722 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33722 33310 BCBST NCCI Refer to Specific Guidelines 33722 33315 BCBST NCCI Refer to Specific Guidelines 33722 33722 BCBST Code redundant to self/should not be reported more than once due to standard description 33722 35226 NCCI NCCI Standards of medical / surgical practice 33722 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 64416 NCCI Misuse of Column 2 code with Column 1 code 33722 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33722 90780 NCCI NCCI Standards of medical / surgical practice 33722 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33730 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33730 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33730 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33730 33141 NCCI NCCI Standards of medical / surgical practice 33730 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33730 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33730 33730 BCBST 33730 35226 NCCI NCCI Standards of medical / surgical practice 33730 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 266 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33730 64416 NCCI Misuse of Column 2 code with Column 1 code 33730 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33730 90780 NCCI NCCI Standards of medical / surgical practice 33730 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33732 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33732 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33732 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33732 33141 NCCI NCCI Standards of medical / surgical practice 33732 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33732 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33732 33310 BCBST NCCI Refer to Specific Guidelines 33732 33315 BCBST NCCI Refer to Specific Guidelines 33732 33732 BCBST Code redundant to self/should not be reported more than once due to standard description 33732 35226 NCCI NCCI Standards of medical / surgical practice 33732 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 64416 NCCI Misuse of Column 2 code with Column 1 code 33732 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33732 90780 NCCI NCCI Standards of medical / surgical practice 33732 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33735 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33735 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33735 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33735 33141 NCCI NCCI Standards of medical / surgical practice 33735 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33735 33211 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 267 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33735 33735 BCBST Code redundant to self/should not be reported more than once due to standard description 33735 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 64416 NCCI Misuse of Column 2 code with Column 1 code 33735 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33735 90780 NCCI NCCI Standards of medical / surgical practice 33735 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33736 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33736 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33736 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33736 33141 NCCI NCCI Standards of medical / surgical practice 33736 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33736 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33736 33310 BCBST NCCI Refer to Specific Guidelines 33736 33315 BCBST NCCI Refer to Specific Guidelines 33736 33735 NCCI NCCI Most extensive procedures 33736 33736 BCBST 33736 35226 NCCI NCCI Standards of medical / surgical practice 33736 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 64416 NCCI Misuse of Column 2 code with Column 1 code 33736 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33736 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 268 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33736 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33737 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33737 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33737 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33737 33141 NCCI NCCI Standards of medical / surgical practice 33737 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33737 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33737 33735 NCCI NCCI Most extensive procedures 33737 33736 NCCI NCCI Most extensive procedures 33737 33737 BCBST 33737 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 64416 NCCI Misuse of Column 2 code with Column 1 code 33737 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33737 90780 NCCI NCCI Standards of medical / surgical practice 33737 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33750 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33750 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33750 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33750 33141 NCCI NCCI Standards of medical / surgical practice 33750 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33750 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33750 33750 BCBST 33750 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 64416 NCCI Misuse of Column 2 code with Column 1 code 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 269 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33750 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33750 90780 NCCI NCCI Standards of medical / surgical practice 33750 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33755 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33755 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33755 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33755 33141 NCCI NCCI Standards of medical / surgical practice 33755 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33755 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33755 33755 BCBST 33755 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 64416 NCCI Misuse of Column 2 code with Column 1 code 33755 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33755 90780 NCCI NCCI Standards of medical / surgical practice 33755 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33762 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33762 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33762 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33762 33141 NCCI NCCI Standards of medical / surgical practice 33762 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33762 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33762 33762 BCBST 33762 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 270 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33762 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 64416 NCCI Misuse of Column 2 code with Column 1 code 33762 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33762 90780 NCCI NCCI Standards of medical / surgical practice 33762 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33764 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33764 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33764 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33764 33141 NCCI NCCI Standards of medical / surgical practice 33764 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33764 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33764 33764 BCBST 33764 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 64416 NCCI Misuse of Column 2 code with Column 1 code 33764 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33764 90780 NCCI NCCI Standards of medical / surgical practice 33764 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33766 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33766 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33766 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33766 33141 NCCI NCCI Standards of medical / surgical practice 33766 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33766 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33766 33766 BCBST 37202 NCCI 33766 CPT TM 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 NCCI Misuse of Column 2 code with Column 1 code is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 271 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33766 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 64416 NCCI Misuse of Column 2 code with Column 1 code 33766 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33766 90780 NCCI NCCI Standards of medical / surgical practice 33766 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33767 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33767 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33767 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33767 33141 NCCI NCCI Standards of medical / surgical practice 33767 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33767 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33767 33310 BCBST NCCI Refer to Specific Guidelines 33767 33315 BCBST NCCI Refer to Specific Guidelines 33767 33766 NCCI 33767 33767 BCBST 33767 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 64416 NCCI Misuse of Column 2 code with Column 1 code 33767 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33767 90780 NCCI NCCI Standards of medical / surgical practice 33767 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33770 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33770 32020 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 272 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33770 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33770 33141 NCCI NCCI Standards of medical / surgical practice 33770 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33770 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33770 33310 BCBST NCCI Refer to Specific Guidelines 33770 33315 BCBST NCCI Refer to Specific Guidelines 33770 33770 BCBST Code redundant to self/should not be reported more than once due to standard description 33770 35226 NCCI NCCI Standards of medical / surgical practice 33770 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 64416 NCCI Misuse of Column 2 code with Column 1 code 33770 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33770 90780 NCCI NCCI Standards of medical / surgical practice 33770 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33771 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33771 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33771 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33771 33141 NCCI NCCI Standards of medical / surgical practice 33771 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33771 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33771 33310 BCBST NCCI Refer to Specific Guidelines 33771 33315 BCBST NCCI Refer to Specific Guidelines 33771 33770 NCCI 33771 33771 BCBST 33771 35226 NCCI NCCI Standards of medical / surgical practice 33771 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI "With" versus "without" procedures Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 273 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33771 64416 NCCI Misuse of Column 2 code with Column 1 code 33771 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33771 90780 NCCI NCCI Standards of medical / surgical practice 33771 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33774 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33774 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33774 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33774 33141 NCCI NCCI Standards of medical / surgical practice 33774 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33774 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33774 33310 BCBST NCCI Refer to Specific Guidelines 33774 33315 BCBST NCCI Refer to Specific Guidelines 33774 33774 BCBST Code redundant to self/should not be reported more than once due to standard description 33774 35226 NCCI NCCI Standards of medical / surgical practice 33774 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 64416 NCCI Misuse of Column 2 code with Column 1 code 33774 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33774 90780 NCCI NCCI Standards of medical / surgical practice 33774 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33775 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33775 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33775 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33775 33141 NCCI NCCI Standards of medical / surgical practice 33775 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33775 33211 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 274 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33775 33310 BCBST NCCI Refer to Specific Guidelines 33775 33315 BCBST NCCI Refer to Specific Guidelines 33775 33774 NCCI 33775 33775 BCBST 33775 35226 NCCI NCCI Standards of medical / surgical practice 33775 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 64416 NCCI Misuse of Column 2 code with Column 1 code 33775 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33775 90780 NCCI NCCI Standards of medical / surgical practice 33775 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33776 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33776 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33776 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33776 33141 NCCI NCCI Standards of medical / surgical practice 33776 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33776 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33776 33310 BCBST NCCI Refer to Specific Guidelines 33776 33315 BCBST NCCI Refer to Specific Guidelines 33776 33774 NCCI 33776 33776 BCBST 33776 35226 NCCI NCCI Standards of medical / surgical practice 33776 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 64416 NCCI Misuse of Column 2 code with Column 1 code 33776 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 275 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33776 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33776 90780 NCCI NCCI Standards of medical / surgical practice 33776 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33777 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33777 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33777 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33777 33141 NCCI NCCI Standards of medical / surgical practice 33777 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33777 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33777 33310 BCBST NCCI Refer to Specific Guidelines 33777 33315 BCBST NCCI Refer to Specific Guidelines 33777 33774 NCCI 33777 33777 BCBST 33777 35226 NCCI NCCI Standards of medical / surgical practice 33777 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 64416 NCCI Misuse of Column 2 code with Column 1 code 33777 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33777 90780 NCCI NCCI Standards of medical / surgical practice 33777 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33778 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33778 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33778 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33778 33141 NCCI NCCI Standards of medical / surgical practice 33778 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33778 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33778 33310 BCBST NCCI Refer to Specific Guidelines 33778 33315 BCBST NCCI Refer to Specific Guidelines CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 276 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33778 33778 BCBST Code redundant to self/should not be reported more than once due to standard description 33778 35226 NCCI NCCI Standards of medical / surgical practice 33778 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 64416 NCCI Misuse of Column 2 code with Column 1 code 33778 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33778 90780 NCCI NCCI Standards of medical / surgical practice 33778 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33779 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33779 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33779 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33779 33141 NCCI NCCI Standards of medical / surgical practice 33779 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33779 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33779 33310 BCBST NCCI Refer to Specific Guidelines 33779 33315 BCBST NCCI Refer to Specific Guidelines 33779 33778 NCCI 33779 33779 BCBST 33779 35226 NCCI NCCI Standards of medical / surgical practice 33779 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 64416 NCCI Misuse of Column 2 code with Column 1 code 33779 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33779 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 277 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33779 90780 NCCI NCCI Standards of medical / surgical practice 33779 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33780 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33780 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33780 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33780 33141 NCCI NCCI Standards of medical / surgical practice 33780 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33780 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33780 33310 BCBST NCCI Refer to Specific Guidelines 33780 33315 BCBST NCCI Refer to Specific Guidelines 33780 33778 NCCI 33780 33780 BCBST 33780 35226 NCCI NCCI Standards of medical / surgical practice 33780 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 64416 NCCI Misuse of Column 2 code with Column 1 code 33780 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33780 90780 NCCI NCCI Standards of medical / surgical practice 33780 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33781 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33781 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33781 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33781 33141 NCCI NCCI Standards of medical / surgical practice 33781 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33781 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33781 33310 BCBST NCCI Refer to Specific Guidelines 33781 33315 BCBST NCCI Refer to Specific Guidelines 33781 33778 NCCI 33781 33781 BCBST 35226 NCCI 33781 CPT TM NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT procedure code definition Code redundant to self/should not be reported more than once due to standard description NCCI Standards of medical / surgical practice is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 278 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33781 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 64416 NCCI Misuse of Column 2 code with Column 1 code 33781 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33781 90780 NCCI NCCI Standards of medical / surgical practice 33781 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33786 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33786 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33786 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33786 33141 NCCI NCCI Standards of medical / surgical practice 33786 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33786 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33786 33786 BCBST 33786 35226 NCCI NCCI Standards of medical / surgical practice 33786 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 64416 NCCI Misuse of Column 2 code with Column 1 code 33786 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33786 90780 NCCI NCCI Standards of medical / surgical practice 33786 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33788 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33788 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33788 33140 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 279 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33788 33141 NCCI NCCI Standards of medical / surgical practice 33788 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33788 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33788 33788 BCBST 33788 35226 NCCI NCCI Standards of medical / surgical practice 33788 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 64416 NCCI Misuse of Column 2 code with Column 1 code 33788 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33788 90780 NCCI NCCI Standards of medical / surgical practice 33788 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33800 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33800 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33800 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33800 33141 NCCI NCCI Standards of medical / surgical practice 33800 33800 BCBST 33800 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 64416 NCCI Misuse of Column 2 code with Column 1 code 33800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33800 90780 NCCI NCCI Standards of medical / surgical practice 33800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33802 32002 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 280 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33802 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33802 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33802 33141 NCCI NCCI Standards of medical / surgical practice 33802 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33802 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33802 33802 BCBST 33802 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 64416 NCCI Misuse of Column 2 code with Column 1 code 33802 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33802 90780 NCCI NCCI Standards of medical / surgical practice 33802 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33803 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33803 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33803 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33803 33141 NCCI NCCI Standards of medical / surgical practice 33803 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33803 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33803 33802 NCCI NCCI HCPCS/CPT procedure code definition 33803 33803 BCBST 33803 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 64416 NCCI Misuse of Column 2 code with Column 1 code 33803 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33803 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 281 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33803 90780 NCCI NCCI Standards of medical / surgical practice 33803 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33813 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33813 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33813 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33813 33141 NCCI NCCI Standards of medical / surgical practice 33813 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33813 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33813 33310 BCBST NCCI Refer to Specific Guidelines 33813 33813 BCBST Procedure redundant to itself. 33813 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 64416 NCCI Misuse of Column 2 code with Column 1 code 33813 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33813 90780 NCCI NCCI Standards of medical / surgical practice 33813 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33814 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33814 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33814 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33814 33141 NCCI NCCI Standards of medical / surgical practice 33814 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33814 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33814 33310 BCBST NCCI Refer to Specific Guidelines 33814 33315 BCBST NCCI Refer to Specific Guidelines 33814 33813 NCCI 33814 33814 BCBST 33814 35226 NCCI NCCI Standards of medical / surgical practice 33814 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI "With" versus "without" procedures Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 282 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33814 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 64416 NCCI Misuse of Column 2 code with Column 1 code 33814 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33814 90780 NCCI NCCI Standards of medical / surgical practice 33814 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33820 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33820 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33820 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33820 33141 NCCI NCCI Standards of medical / surgical practice 33820 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33820 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33820 33820 BCBST 33820 33822 NCCI NCCI Mutually exclusive procedures 33820 33824 NCCI NCCI Mutually exclusive procedures 33820 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 64416 NCCI Misuse of Column 2 code with Column 1 code 33820 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33820 90780 NCCI NCCI Standards of medical / surgical practice 33820 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33822 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33822 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33822 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33822 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33822 33822 BCBST 33822 33824 NCCI NCCI Mutually exclusive procedures 33822 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 283 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33822 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 64416 NCCI Misuse of Column 2 code with Column 1 code 33822 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33822 90780 NCCI NCCI Standards of medical / surgical practice 33822 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33824 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33824 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33824 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33824 33141 NCCI NCCI Standards of medical / surgical practice 33824 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33824 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33824 33824 BCBST 33824 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 64416 NCCI Misuse of Column 2 code with Column 1 code 33824 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33824 90780 NCCI NCCI Standards of medical / surgical practice 33824 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33840 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33840 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33840 33141 NCCI NCCI Standards of medical / surgical practice 33840 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33840 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33840 33840 BCBST CPT TM Procedure redundant to itself. Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 284 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33840 33851 NCCI NCCI Mutually exclusive procedures 33840 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 64416 NCCI Misuse of Column 2 code with Column 1 code 33840 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33840 90780 NCCI NCCI Standards of medical / surgical practice 33840 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33845 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33845 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33845 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33845 33141 NCCI NCCI Standards of medical / surgical practice 33845 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33845 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33845 33845 BCBST 33845 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 64416 NCCI Misuse of Column 2 code with Column 1 code 33845 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33845 90780 NCCI NCCI Standards of medical / surgical practice 33845 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33851 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33851 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33851 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33851 33141 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 285 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33851 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33851 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33851 33845 NCCI NCCI Mutually exclusive procedures 33851 33851 BCBST 33851 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 64416 NCCI Misuse of Column 2 code with Column 1 code 33851 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33851 90780 NCCI NCCI Standards of medical / surgical practice 33851 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33852 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33852 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33852 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33852 33141 NCCI NCCI Standards of medical / surgical practice 33852 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33852 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33852 33852 BCBST 33852 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 64416 NCCI Misuse of Column 2 code with Column 1 code 33852 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33852 90780 NCCI NCCI Standards of medical / surgical practice 33852 S0020 CPT CMS 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 TM Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 286 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33853 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33853 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33853 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33853 33141 NCCI NCCI Standards of medical / surgical practice 33853 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33853 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33853 33310 BCBST NCCI Refer to Specific Guidelines 33853 33315 BCBST NCCI Refer to Specific Guidelines 33853 33852 NCCI 33853 33853 BCBST 33853 35226 NCCI NCCI Standards of medical / surgical practice 33853 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 64416 NCCI Misuse of Column 2 code with Column 1 code 33853 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33853 90780 NCCI NCCI Standards of medical / surgical practice 33853 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33860 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33860 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33860 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33860 33141 NCCI NCCI Standards of medical / surgical practice 33860 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33860 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33860 33310 BCBST NCCI Refer to Specific Guidelines 33860 33315 BCBST NCCI Refer to Specific Guidelines 33860 33530 NCCI 33860 33860 BCBST 33860 35226 NCCI NCCI Standards of medical / surgical practice 33860 35820 NCCI NCCI Standards of medical / surgical practice 33860 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI "With" versus "without" procedures Code redundant to self/should not be reported more than once due to standard description NCCI HCPCS/CPT coding manual instruction / guideline Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 287 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33860 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 64416 NCCI Misuse of Column 2 code with Column 1 code 33860 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33860 90780 NCCI NCCI Standards of medical / surgical practice 33860 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33861 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33861 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33861 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33861 33141 NCCI NCCI Standards of medical / surgical practice 33861 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33861 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33861 33310 BCBST NCCI Refer to Specific Guidelines 33861 33315 BCBST NCCI Refer to Specific Guidelines 33861 33530 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 33861 33860 NCCI NCCI HCPCS/CPT procedure code definition 33861 33861 BCBST 33861 33970 NCCI NCCI Standards of medical / surgical practice 33861 35226 NCCI NCCI Standards of medical / surgical practice 33861 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 64416 NCCI Misuse of Column 2 code with Column 1 code 33861 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33861 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 288 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33861 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33863 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33863 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33863 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33863 33141 NCCI NCCI Standards of medical / surgical practice 33863 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33863 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33863 33310 BCBST NCCI Refer to Specific Guidelines 33863 33315 BCBST NCCI Refer to Specific Guidelines 33863 33860 NCCI NCCI HCPCS/CPT procedure code definition 33863 33861 NCCI NCCI HCPCS/CPT procedure code definition 33863 33863 BCBST 33863 33970 NCCI NCCI Standards of medical / surgical practice 33863 35226 NCCI NCCI Standards of medical / surgical practice 33863 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 64416 NCCI Misuse of Column 2 code with Column 1 code 33863 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33863 90780 NCCI NCCI Standards of medical / surgical practice 33863 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33870 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33870 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33870 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33870 33141 NCCI NCCI Standards of medical / surgical practice 33870 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33870 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33870 33870 BCBST 33870 35226 NCCI NCCI Standards of medical / surgical practice 33870 35820 NCCI NCCI Standards of medical / surgical practice 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 289 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33870 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 64416 NCCI Misuse of Column 2 code with Column 1 code 33870 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33870 90780 NCCI NCCI Standards of medical / surgical practice 33870 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33875 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33875 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33875 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33875 33141 NCCI NCCI Standards of medical / surgical practice 33875 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33875 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33875 33875 BCBST 33875 35226 NCCI NCCI Standards of medical / surgical practice 33875 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 64416 NCCI Misuse of Column 2 code with Column 1 code 33875 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33875 90780 NCCI NCCI Standards of medical / surgical practice 33875 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33877 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33877 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33877 33141 NCCI NCCI Standards of medical / surgical practice 33877 33210 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 290 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33877 33211 NCCI 33877 33877 BCBST 33877 35226 NCCI NCCI Standards of medical / surgical practice 33877 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 64416 NCCI Misuse of Column 2 code with Column 1 code 33877 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33877 90780 NCCI NCCI Standards of medical / surgical practice 33877 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33910 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33910 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33910 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33910 33141 NCCI NCCI Standards of medical / surgical practice 33910 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33910 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33910 33910 BCBST 33910 33915 NCCI NCCI "With" versus "without" procedures 33910 33916 NCCI NCCI Mutually exclusive procedures 33910 35226 NCCI NCCI Standards of medical / surgical practice 33910 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 64416 NCCI Misuse of Column 2 code with Column 1 code 33910 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33910 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT separate procedure definition 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 291 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33910 90780 NCCI NCCI Standards of medical / surgical practice 33910 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33915 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33915 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33915 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33915 33141 NCCI NCCI Standards of medical / surgical practice 33915 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33915 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33915 33915 BCBST 33915 33916 NCCI NCCI Mutually exclusive procedures 33915 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 64416 NCCI Misuse of Column 2 code with Column 1 code 33915 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33915 90780 NCCI NCCI Standards of medical / surgical practice 33915 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33916 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33916 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33916 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33916 33141 NCCI NCCI Standards of medical / surgical practice 33916 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33916 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33916 33310 BCBST NCCI Refer to Specific Guidelines 33916 33315 BCBST NCCI Refer to Specific Guidelines 33916 33916 BCBST Code redundant to self/should not be reported more than once due to standard description 33916 35226 NCCI NCCI Standards of medical / surgical practice 33916 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 292 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33916 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 64416 NCCI Misuse of Column 2 code with Column 1 code 33916 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33916 90780 NCCI NCCI Standards of medical / surgical practice 33916 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33917 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33917 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33917 33141 NCCI NCCI Standards of medical / surgical practice 33917 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33917 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33917 33310 BCBST NCCI Refer to Specific Guidelines 33917 33315 BCBST NCCI Refer to Specific Guidelines 33917 33917 BCBST Code redundant to self/should not be reported more than once due to standard description 33917 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 64416 NCCI Misuse of Column 2 code with Column 1 code 33917 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33917 90780 NCCI NCCI Standards of medical / surgical practice 33917 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33918 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33918 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33918 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33918 33141 NCCI NCCI Standards of medical / surgical practice 33918 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33918 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33918 33310 BCBST CPT TM NCCI Refer to Specific Guidelines is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 293 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33918 33315 BCBST NCCI Refer to Specific Guidelines 33918 33918 BCBST Code redundant to self/should not be reported more than once due to standard description 33918 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 64416 NCCI Misuse of Column 2 code with Column 1 code 33918 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33918 90780 NCCI NCCI Standards of medical / surgical practice 33918 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33919 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33919 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33919 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33919 33141 NCCI NCCI Standards of medical / surgical practice 33919 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33919 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33919 33310 BCBST NCCI Refer to Specific Guidelines 33919 33315 BCBST NCCI Refer to Specific Guidelines 33919 33918 NCCI 33919 33919 BCBST 33919 35226 NCCI NCCI Standards of medical / surgical practice 33919 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 64416 NCCI Misuse of Column 2 code with Column 1 code 33919 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33919 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI "With" versus "without" procedures Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 294 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33919 90780 NCCI NCCI Standards of medical / surgical practice 33919 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33920 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33920 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33920 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33920 33141 NCCI NCCI Standards of medical / surgical practice 33920 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33920 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33920 33310 BCBST NCCI Refer to Specific Guidelines 33920 33315 BCBST NCCI Refer to Specific Guidelines 33920 33920 BCBST Code redundant to self/should not be reported more than once due to standard description 33920 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 64416 NCCI Misuse of Column 2 code with Column 1 code 33920 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33920 90780 NCCI NCCI Standards of medical / surgical practice 33920 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33922 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33922 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33922 33140 NCCI NCCI HCPCS/CPT separate procedure definition 33922 33141 NCCI NCCI Standards of medical / surgical practice 33922 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33922 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33922 33310 BCBST NCCI Refer to Specific Guidelines 33922 33315 BCBST NCCI Refer to Specific Guidelines 33922 33922 BCBST Code redundant to self/should not be reported more than once due to standard description 33922 35226 NCCI NCCI Standards of medical / surgical practice 33922 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 295 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33922 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 64416 NCCI Misuse of Column 2 code with Column 1 code 33922 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33922 90780 NCCI NCCI Standards of medical / surgical practice 33922 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33924 33924 BCBST 33924 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33930 32440 NCCI Misuse of Column 2 code with Column 1 code 33930 32442 NCCI Misuse of Column 2 code with Column 1 code 33930 32445 NCCI Misuse of Column 2 code with Column 1 code 33930 32480 NCCI Misuse of Column 2 code with Column 1 code 33930 32482 NCCI Misuse of Column 2 code with Column 1 code 33930 32484 NCCI Misuse of Column 2 code with Column 1 code 33930 32486 NCCI Misuse of Column 2 code with Column 1 code 33930 32488 NCCI Misuse of Column 2 code with Column 1 code 33930 32491 NCCI Misuse of Column 2 code with Column 1 code 33930 32500 NCCI Misuse of Column 2 code with Column 1 code 33930 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33930 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33930 33930 BCBST 33930 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 64416 NCCI Misuse of Column 2 code with Column 1 code 33930 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33930 90780 NCCI NCCI Standards of medical / surgical practice CPT TM Procedure redundant to itself. Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 296 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33930 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33935 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33935 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33935 32440 NCCI HCPCS/CPT procedure code definition 33935 32442 NCCI HCPCS/CPT procedure code definition 33935 32445 NCCI HCPCS/CPT procedure code definition 33935 32480 NCCI HCPCS/CPT procedure code definition 33935 32482 NCCI HCPCS/CPT procedure code definition 33935 32484 NCCI HCPCS/CPT procedure code definition 33935 32486 NCCI HCPCS/CPT procedure code definition 33935 32488 NCCI HCPCS/CPT procedure code definition 33935 32491 NCCI HCPCS/CPT procedure code definition 33935 32500 NCCI HCPCS/CPT procedure code definition 33935 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33935 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33935 33935 BCBST 33935 35226 NCCI NCCI Standards of medical / surgical practice 33935 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 64416 NCCI Misuse of Column 2 code with Column 1 code 33935 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33935 90780 NCCI NCCI Standards of medical / surgical practice 33935 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33940 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33940 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33940 33940 BCBST 33940 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 297 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33940 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 64416 NCCI Misuse of Column 2 code with Column 1 code 33940 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33940 90780 NCCI NCCI Standards of medical / surgical practice 33940 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33945 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33945 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33945 33210 NCCI NCCI HCPCS/CPT separate procedure definition 33945 33211 NCCI NCCI HCPCS/CPT separate procedure definition 33945 33945 BCBST 33945 35226 NCCI NCCI Standards of medical / surgical practice 33945 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 64416 NCCI Misuse of Column 2 code with Column 1 code 33945 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33945 90780 NCCI NCCI Standards of medical / surgical practice 33945 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33960 33960 BCBST 33960 35226 NCCI NCCI Standards of medical / surgical practice 33960 35820 NCCI NCCI Standards of medical / surgical practice 33960 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 64416 NCCI Misuse of Column 2 code with Column 1 code 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 298 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33960 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33960 90780 NCCI NCCI Standards of medical / surgical practice 33960 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33961 33961 BCBST 33961 35226 NCCI NCCI Standards of medical / surgical practice 33961 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33967 33967 BCBST 33967 34812 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 34813 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 35201 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 35206 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 35226 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 35261 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 35266 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 35286 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental repair of vessels included in the listed procedure. 33967 36140 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental needle or catheter placement included in the listed procedure. 33967 36200 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental catheter introduction included in the listed procedure. 33967 36215 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental catheter introduction included in the listed procedure. 33967 36216 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental catheter introduction included in the listed procedure. 33967 36217 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental catheter introduction included in the listed procedure. 33967 36218 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental catheter introduction included in the listed procedure. 33967 36600 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental arterial puncture included in the listed procedure. 33967 36620 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental arterial catheterization included in the listed procedure. 33967 36625 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental arterial catheterization included in the listed procedure. 33967 37202 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental transcatheter infusion included in the listed procedure. CPT TM Code redundant to self/should not be reported more than once due to standard description Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 299 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33967 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 64416 NCCI Misuse of Column 2 code with Column 1 code 33967 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33967 71034 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report radiologic or flouroscopic evaluation of device placement included in the listed procedure. 33967 76000 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed when used to report fluoroscopy required to perform the definitive procedure. 33967 76001 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed when used to report fluoroscopy required to perform the definitive procedure. 33967 90780 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 33967 90781 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 33967 90784 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. Similar listed codes with edit disallowed according to NCCI Standards of medical / surgical practice. 33967 93562 BCBST NCCI Standards of medical / surgical practice / Edited code not allowed if used to report incidental measurement of cardiac output included in the listed procedure. 33967 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33968 33967 BCBST 33968 33967 NCCI NCCI Mutually exclusive procedures 33968 33967 NCCI NCCI Mutually exclusive procedures 33968 33968 BCBST 33968 33970 NCCI NCCI Mutually exclusive procedures 33968 33973 NCCI NCCI Mutually exclusive procedures 33968 35226 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 35256 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 35286 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 64416 NCCI Misuse of Column 2 code with Column 1 code 33968 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 300 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33968 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33968 90780 NCCI NCCI Standards of medical / surgical practice 33968 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33970 33967 BCBST NCCI Refer to Specific Guidelines 33970 33967 NCCI NCCI Most extensive procedures 33970 33967 NCCI NCCI Most extensive procedures 33970 33970 BCBST 33970 35226 NCCI NCCI Standards of medical / surgical practice 33970 35820 NCCI NCCI Standards of medical / surgical practice 33970 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 64416 NCCI Misuse of Column 2 code with Column 1 code 33970 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33970 90780 NCCI NCCI Standards of medical / surgical practice 33970 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33971 33967 BCBST 33971 33967 NCCI NCCI Mutually exclusive procedures 33971 33967 NCCI NCCI Mutually exclusive procedures 33971 33968 NCCI NCCI Most extensive procedures 33971 33970 NCCI NCCI Mutually exclusive procedures 33971 33971 BCBST 33971 35226 NCCI NCCI HCPCS/CPT procedure code definition 33971 35256 NCCI NCCI HCPCS/CPT procedure code definition 33971 35286 NCCI NCCI HCPCS/CPT procedure code definition 33971 35820 NCCI NCCI Standards of medical / surgical practice 33971 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 CPT TM Code redundant to self/should not be reported more than once due to standard description NCCI Refer to Specific Guidelines Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 301 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33971 64416 NCCI Misuse of Column 2 code with Column 1 code 33971 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33971 90780 NCCI NCCI Standards of medical / surgical practice 33971 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33973 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33973 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33973 33973 BCBST 33973 33974 NCCI NCCI Mutually exclusive procedures 33973 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 64416 NCCI Misuse of Column 2 code with Column 1 code 33973 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33973 90780 NCCI NCCI Standards of medical / surgical practice 33973 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33974 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33974 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33974 33320 NCCI NCCI HCPCS/CPT procedure code definition 33974 33321 NCCI NCCI HCPCS/CPT procedure code definition 33974 33322 NCCI NCCI HCPCS/CPT procedure code definition 33974 33330 NCCI NCCI HCPCS/CPT procedure code definition 33974 33332 NCCI NCCI HCPCS/CPT procedure code definition 33974 33335 NCCI NCCI HCPCS/CPT procedure code definition 33974 33968 NCCI NCCI Most extensive procedures 33974 33974 BCBST 33974 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 302 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33974 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 64416 NCCI Misuse of Column 2 code with Column 1 code 33974 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33974 90780 NCCI NCCI Standards of medical / surgical practice 33974 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33975 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33975 33975 BCBST 33975 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 64416 NCCI Misuse of Column 2 code with Column 1 code 33975 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33975 90780 NCCI NCCI Standards of medical / surgical practice 33975 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33976 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33976 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33976 33975 NCCI NCCI HCPCS/CPT procedure code definition 33976 33976 BCBST 33976 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 64416 NCCI Misuse of Column 2 code with Column 1 code 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 303 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33976 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33976 90780 NCCI NCCI Standards of medical / surgical practice 33976 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33977 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33977 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33977 33977 BCBST 33977 35820 NCCI NCCI Standards of medical / surgical practice 33977 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 64416 NCCI Misuse of Column 2 code with Column 1 code 33977 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33977 90780 NCCI NCCI Standards of medical / surgical practice 33977 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33978 32002 NCCI NCCI HCPCS/CPT separate procedure definition 33978 32020 NCCI NCCI HCPCS/CPT separate procedure definition 33978 33977 NCCI NCCI HCPCS/CPT procedure code definition 33978 33978 BCBST 33978 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 64416 NCCI Misuse of Column 2 code with Column 1 code 33978 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33978 CPT TM 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 is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 304 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33978 Source Rationale 69990 NCCI 33978 90780 NCCI NCCI Standards of medical / surgical practice 33978 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 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. 33979 32002 NCCI 33979 32020 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. 33979 32100 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33979 32160 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33979 33300 BCBST Edited code not allowed if used to report repair of surgical wounds produced in performing the listed procedure. 33979 33305 BCBST Edited code not allowed if used to report repair of surgical wounds produced in performing the listed procedure. 33979 33310 BCBST Edited code not allowed if used to report cardiotomy included in the listed procedure. 33979 33315 BCBST Edited code not allowed if used to report cardiotomy included in the listed procedure. CPT TM NCCI Misuse of Column 2 code with Column 1 code NCCI HCPCS/CPT separate procedure definition is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 305 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33979 33320 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33979 33321 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33979 33322 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33979 33975 BCBST NCCI HCPCS/CPT procedure code definition / Edited code is incompatible or redundant to the listed procedure. 33979 33976 BCBST NCCI HCPCS/CPT procedure code definition / Edited code is incompatible or redundant to the listed procedure. 33979 33979 BCBST Procedure redundant to itself. 33979 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 64416 NCCI Misuse of Column 2 code with Column 1 code 33979 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 33979 90780 NCCI NCCI Standards of medical / surgical practice 33979 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 306 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 33980 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. 33980 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. 33980 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. 33980 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. 33980 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. 33980 32002 NCCI 33980 32020 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. 33980 32100 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33980 32160 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 33980 33300 BCBST Edited code not allowed if used to report repair of surgical wounds produced in performing the listed procedure. 33980 33305 BCBST Edited code not allowed if used to report repair of surgical wounds produced in performing the listed procedure. 33980 33310 BCBST Edited code not allowed if used to report cardiotomy included in the listed procedure. 33980 33315 BCBST Edited code not allowed if used to report cardiotomy included in the listed procedure. 33980 33320 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33980 33321 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33980 33322 BCBST Edited code not allowed if used to report repair of aorta or great vessel wounds surgically produced in performing the listed procedure. 33980 33977 BCBST NCCI HCPCS/CPT procedure code definition / Edited code is incompatible or redundant to the listed procedure. 33980 33978 BCBST NCCI HCPCS/CPT procedure code definition / Edited code is incompatible or redundant to the listed procedure. 33980 33980 BCBST Procedure redundant to itself. 33980 37202 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 39010 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 64416 NCCI Misuse of Column 2 code with Column 1 code 33980 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 33980 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI HCPCS/CPT separate procedure definition is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 307 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code 33980 Source Rationale 69990 NCCI 33980 90780 NCCI NCCI Standards of medical / surgical practice 33980 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 33999 33999 BCBST 33999 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34001 01925 NCCI NCCI Anesthesia included in surgical procedures 34001 35701 NCCI NCCI Standards of medical / surgical practice 34001 36000 NCCI NCCI Standards of medical / surgical practice 34001 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 36100 NCCI NCCI Standards of medical / surgical practice 34001 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34001 37202 NCCI NCCI Standards of medical / surgical practice 34001 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 64416 NCCI Misuse of Column 2 code with Column 1 code 34001 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34001 90780 NCCI NCCI Standards of medical / surgical practice 34001 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34051 32002 NCCI NCCI HCPCS/CPT separate procedure definition 34051 32020 NCCI NCCI HCPCS/CPT separate procedure definition 34051 35761 NCCI NCCI Standards of medical / surgical practice 34051 36000 NCCI NCCI Standards of medical / surgical practice 34051 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 36100 NCCI NCCI Standards of medical / surgical practice 34051 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34051 37202 NCCI NCCI Standards of medical / surgical practice 34051 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 64416 NCCI Misuse of Column 2 code with Column 1 code 34051 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM NCCI Misuse of Column 2 code with Column 1 code Procedure redundant to itself. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 308 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34051 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34051 90780 NCCI NCCI Standards of medical / surgical practice 34051 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34101 35206 NCCI NCCI Standards of medical / surgical practice 34101 35236 NCCI NCCI Standards of medical / surgical practice 34101 35266 NCCI NCCI Standards of medical / surgical practice 34101 35761 NCCI NCCI Standards of medical / surgical practice 34101 36000 NCCI NCCI Standards of medical / surgical practice 34101 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 36120 NCCI NCCI Standards of medical / surgical practice 34101 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34101 37202 NCCI NCCI Standards of medical / surgical practice 34101 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 64416 NCCI Misuse of Column 2 code with Column 1 code 34101 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34101 90780 NCCI NCCI Standards of medical / surgical practice 34101 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34111 35206 NCCI NCCI Standards of medical / surgical practice 34111 35236 NCCI NCCI Standards of medical / surgical practice 34111 35266 NCCI NCCI Standards of medical / surgical practice 34111 36000 NCCI NCCI Standards of medical / surgical practice 34111 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 36140 NCCI NCCI Standards of medical / surgical practice 34111 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34111 37202 NCCI NCCI Standards of medical / surgical practice 34111 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 64416 NCCI Misuse of Column 2 code with Column 1 code 34111 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 309 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34111 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34111 90780 NCCI NCCI Standards of medical / surgical practice 34111 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34151 34820 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 35761 NCCI NCCI Standards of medical / surgical practice 34151 36000 NCCI NCCI Standards of medical / surgical practice 34151 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 36200 NCCI NCCI Standards of medical / surgical practice 34151 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34151 37202 NCCI NCCI Standards of medical / surgical practice 34151 49000 NCCI NCCI HCPCS/CPT separate procedure definition 34151 49002 NCCI NCCI Standards of medical / surgical practice 34151 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 64416 NCCI Misuse of Column 2 code with Column 1 code 34151 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34151 90780 NCCI NCCI Standards of medical / surgical practice 34151 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34201 34812 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 34813 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 35226 NCCI NCCI Standards of medical / surgical practice 34201 35286 NCCI NCCI Standards of medical / surgical practice 34201 35721 NCCI NCCI Standards of medical / surgical practice 34201 35741 NCCI NCCI Standards of medical / surgical practice 34201 35860 NCCI NCCI Standards of medical / surgical practice 34201 36000 NCCI NCCI Standards of medical / surgical practice 34201 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 36140 NCCI NCCI Standards of medical / surgical practice 34201 36200 NCCI NCCI Standards of medical / surgical practice 34201 36410 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 310 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34201 37202 NCCI NCCI Standards of medical / surgical practice 34201 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 64416 NCCI Misuse of Column 2 code with Column 1 code 34201 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34201 90780 NCCI NCCI Standards of medical / surgical practice 34201 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34203 34813 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 35226 NCCI NCCI Standards of medical / surgical practice 34203 35256 NCCI NCCI Standards of medical / surgical practice 34203 35286 NCCI NCCI Standards of medical / surgical practice 34203 35741 NCCI NCCI Standards of medical / surgical practice 34203 36000 NCCI NCCI Standards of medical / surgical practice 34203 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 36140 NCCI NCCI Standards of medical / surgical practice 34203 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34203 37202 NCCI NCCI Standards of medical / surgical practice 34203 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 64416 NCCI Misuse of Column 2 code with Column 1 code 34203 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34203 90780 NCCI NCCI Standards of medical / surgical practice 34203 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34401 34820 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 36000 NCCI NCCI Standards of medical / surgical practice 34401 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 36010 NCCI NCCI Standards of medical / surgical practice 34401 36410 NCCI NCCI HCPCS/CPT separate procedure definition CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 311 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34401 37202 NCCI NCCI Standards of medical / surgical practice 34401 49000 NCCI NCCI HCPCS/CPT separate procedure definition 34401 49002 NCCI NCCI Standards of medical / surgical practice 34401 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 64416 NCCI Misuse of Column 2 code with Column 1 code 34401 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34401 90780 NCCI NCCI Standards of medical / surgical practice 34401 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34421 34812 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 34813 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 35226 NCCI NCCI Standards of medical / surgical practice 34421 35256 NCCI NCCI Standards of medical / surgical practice 34421 35286 NCCI NCCI Standards of medical / surgical practice 34421 36000 NCCI NCCI Standards of medical / surgical practice 34421 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 36010 NCCI NCCI Standards of medical / surgical practice 34421 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34421 37202 NCCI NCCI Standards of medical / surgical practice 34421 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 64416 NCCI Misuse of Column 2 code with Column 1 code 34421 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34421 90780 NCCI NCCI Standards of medical / surgical practice 34421 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34451 34401 NCCI NCCI Most extensive procedures 34451 34421 NCCI NCCI Most extensive procedures 34451 34812 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 312 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34451 34813 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 36000 NCCI NCCI Standards of medical / surgical practice 34451 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 36010 NCCI NCCI Standards of medical / surgical practice 34451 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34451 37202 NCCI NCCI Standards of medical / surgical practice 34451 49000 NCCI NCCI HCPCS/CPT separate procedure definition 34451 49002 NCCI NCCI Standards of medical / surgical practice 34451 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 64416 NCCI Misuse of Column 2 code with Column 1 code 34451 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34451 90780 NCCI NCCI Standards of medical / surgical practice 34451 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34471 36000 NCCI NCCI Standards of medical / surgical practice 34471 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34471 37202 NCCI NCCI Standards of medical / surgical practice 34471 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 64416 NCCI Misuse of Column 2 code with Column 1 code 34471 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34471 90780 NCCI NCCI Standards of medical / surgical practice 34471 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34490 35206 NCCI NCCI Standards of medical / surgical practice 34490 35236 NCCI NCCI Standards of medical / surgical practice 34490 35266 NCCI NCCI Standards of medical / surgical practice 34490 36000 NCCI NCCI Standards of medical / surgical practice CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 313 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34490 36002 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 36410 NCCI NCCI HCPCS/CPT separate procedure definition 34490 36831 NCCI NCCI Mutually exclusive procedures 34490 37202 NCCI NCCI Standards of medical / surgical practice 34490 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 64416 NCCI Misuse of Column 2 code with Column 1 code 34490 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34490 90780 NCCI NCCI Standards of medical / surgical practice 34490 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34501 37202 NCCI NCCI Standards of medical / surgical practice 34501 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 64416 NCCI Misuse of Column 2 code with Column 1 code 34501 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34501 90780 NCCI NCCI Standards of medical / surgical practice 34501 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34502 32002 NCCI NCCI HCPCS/CPT separate procedure definition 34502 32020 NCCI NCCI HCPCS/CPT separate procedure definition 34502 34502 BCBST 34502 37202 NCCI NCCI Standards of medical / surgical practice 34502 49000 NCCI NCCI HCPCS/CPT separate procedure definition 34502 49002 NCCI NCCI Standards of medical / surgical practice 34502 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 64416 NCCI Misuse of Column 2 code with Column 1 code CPT TM Code redundant to self/should not be reported more than once due to standard description is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 314 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34502 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34502 90780 NCCI NCCI Standards of medical / surgical practice 34502 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34510 35860 NCCI NCCI Standards of medical / surgical practice 34510 37202 NCCI NCCI Standards of medical / surgical practice 34510 49000 NCCI NCCI HCPCS/CPT separate procedure definition 34510 49002 NCCI NCCI Standards of medical / surgical practice 34510 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 64416 NCCI Misuse of Column 2 code with Column 1 code 34510 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34510 90780 NCCI NCCI Standards of medical / surgical practice 34510 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34520 37202 NCCI NCCI Standards of medical / surgical practice 34520 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 64416 NCCI Misuse of Column 2 code with Column 1 code 34520 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34520 90780 NCCI NCCI Standards of medical / surgical practice 34520 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34530 37202 NCCI NCCI Standards of medical / surgical practice 34530 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 315 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34530 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 64416 NCCI Misuse of Column 2 code with Column 1 code 34530 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34530 90780 NCCI NCCI Standards of medical / surgical practice 34530 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34800 01926 NCCI NCCI Anesthesia included in surgical procedures 34800 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13120 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13121 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34800 13122 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 316 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34800 34800 BCBST Procedure redundant to itself. 34800 35081 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34800 35082 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34800 35091 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34800 35092 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34800 35102 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34800 35103 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34800 35226 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. 34800 35286 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 35452 NCCI 34800 35472 BCBST 34800 36000 NCCI 34800 36120 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36140 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36200 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36245 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36246 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36247 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36248 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34800 36410 NCCI NCCI Standards of medical / surgical practice 34800 36620 NCCI NCCI HCPCS/CPT separate procedure definition 34800 36625 NCCI NCCI HCPCS/CPT separate procedure definition 34800 37202 BCBST CPT TM NCCI HCPCS/CPT coding manual instruction / guideline 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. NCCI Standards of medical / surgical practice NCCI Standards of medical / surgical practice / The edited code is a component of the listed code when performed as part of the listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 317 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34800 37205 NCCI NCCI Mutually exclusive procedures 34800 37207 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34800 37209 NCCI NCCI Most extensive procedures 34800 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 64416 NCCI Misuse of Column 2 code with Column 1 code 34800 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34800 75625 NCCI NCCI Standards of medical / surgical practice 34800 75630 NCCI NCCI Standards of medical / surgical practice 34800 75960 NCCI HCPCS/CPT coding manual instruction / guideline 34800 76000 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. 34800 76001 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. 34800 76003 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. 34800 76942 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. 34800 90780 NCCI NCCI Standards of medical / surgical practice 34800 G0275 NCCI Misuse of Column 2 code with Column 1 code 34800 G0278 NCCI Misuse of Column 2 code with Column 1 code 34800 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34802 01926 NCCI NCCI Anesthesia included in surgical procedures 34802 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 318 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34802 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13120 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13121 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 13122 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34802 34800 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 34802 BCBST Procedure redundant to itself. 34802 34808 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 35081 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34802 35082 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34802 35091 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34802 35092 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34802 35102 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34802 35103 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34802 35226 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. 34802 35286 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 35452 NCCI 34802 CPT TM NCCI HCPCS/CPT coding manual instruction / guideline is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 319 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34802 35454 NCCI 34802 35472 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. 34802 35473 BCBST NCCI Refer to Specific Guidelines 34802 35473 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34802 35473 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34802 36000 NCCI NCCI Standards of medical / surgical practice 34802 36120 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36140 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36200 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36245 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36246 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36247 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36248 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34802 36410 NCCI NCCI Standards of medical / surgical practice 34802 36620 NCCI NCCI HCPCS/CPT separate procedure definition 34802 36625 NCCI NCCI HCPCS/CPT separate procedure definition 34802 37202 BCBST 34802 37205 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34802 37207 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34802 37209 NCCI NCCI Most extensive procedures 34802 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 64416 NCCI Misuse of Column 2 code with Column 1 code 34802 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34802 75625 NCCI NCCI Standards of medical / surgical practice 34802 75630 NCCI NCCI Standards of medical / surgical practice 34802 75960 NCCI HCPCS/CPT coding manual instruction / guideline 34802 76000 BCBST CPT TM NCCI HCPCS/CPT coding manual instruction / guideline NCCI Standards of medical / surgical practice / 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. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 320 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34802 76001 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. 34802 76003 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. 34802 76942 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. 34802 90780 NCCI NCCI Standards of medical / surgical practice 34802 G0275 NCCI Misuse of Column 2 code with Column 1 code 34802 G0278 NCCI Misuse of Column 2 code with Column 1 code 34802 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34804 01926 NCCI NCCI Anesthesia included in surgical procedures 34804 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13120 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13121 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34804 13122 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 321 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34804 34800 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 34802 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 34804 BCBST Procedure redundant to itself. 34804 34808 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 35081 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34804 35082 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34804 35091 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34804 35092 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34804 35102 BCBST NCCI Misuse of Column 2 code with Column 1 code / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 3483034832 do not apply. 34804 35103 BCBST NCCI Mutually exclusive procedures / Redundant procedures. Review medial records before reimbursing the edited procedure to confirm that an open repair was performed and that other codes in the 34812-34820 and 34830-34832 do not apply. 34804 35226 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. 34804 35286 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 35452 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 35454 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 35472 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. 34804 35473 BCBST NCCI Refer to Specific Guidelines 34804 35473 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 35473 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 36000 NCCI NCCI Standards of medical / surgical practice 34804 36120 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36140 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36200 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36245 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 322 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34804 36246 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36247 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36248 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34804 36410 NCCI NCCI Standards of medical / surgical practice 34804 36620 NCCI NCCI HCPCS/CPT separate procedure definition 34804 36625 NCCI NCCI HCPCS/CPT separate procedure definition 34804 37202 BCBST 34804 37205 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 37207 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34804 37209 NCCI NCCI Most extensive procedures 34804 62318 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 62319 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 64415 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 64416 NCCI Misuse of Column 2 code with Column 1 code 34804 64417 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 64450 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 64470 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 64475 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34804 75625 NCCI NCCI Standards of medical / surgical practice 34804 75630 NCCI NCCI Standards of medical / surgical practice 34804 75960 NCCI HCPCS/CPT coding manual instruction / guideline 34804 76000 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. 34804 76001 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. 34804 76003 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. 34804 76942 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. 34804 90780 NCCI NCCI Standards of medical / surgical practice 34804 G0275 NCCI Misuse of Column 2 code with Column 1 code 34804 G0278 NCCI Misuse of Column 2 code with Column 1 code 34804 S0020 CPT CMS notes that bupivacaine HCl should not be separately payable; CPT guidelines indicate that local infiltration and/or analgesia is included in the surgical package 34808 01926 NCCI NCCI Anesthesia included in surgical procedures 34808 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT TM NCCI Standards of medical / surgical practice / The edited code is a component of the listed code when performed as part of the listed procedure. is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 323 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34808 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13101 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13102 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13120 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13121 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 13122 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34808 35226 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. 34808 35286 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 35454 NCCI NCCI Mutually exclusive procedures 34808 35473 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34808 36000 NCCI NCCI Standards of medical / surgical practice 34808 36140 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 36200 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 36245 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 36246 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 36247 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. CPT TM is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 324 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34808 36248 BCBST The edited code is a component of the listed code when performed as part of the listed procedure. 34808 36410 NCCI NCCI Standards of medical / surgical practice 34808 36620 NCCI NCCI HCPCS/CPT separate procedure definition 34808 36625 NCCI NCCI HCPCS/CPT separate procedure definition 34808 37202 BCBST 34808 37205 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34808 37207 NCCI NCCI HCPCS/CPT coding manual instruction / guideline 34808 69990 NCCI NCCI Misuse of Column 2 code with Column 1 code 34808 76000 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. 34808 76001 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. 34808 76003 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. 34808 76942 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. 34808 S0020 CPT 34812 01926 NCCI 34812 12001 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12002 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12004 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12005 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12006 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12007 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12031 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12032 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12034 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12035 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12036 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 12037 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. 34812 13100 BCBST Edited code not allowed when used to report closure of wound or repair of tissues divided for initial surgical exposure. CPT TM NCCI Standards of medical / surgical practice / The edited code is a component of the listed code when performed as part of the listed 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 NCCI Anesthesia included in surgical procedures is a registered trademark of the American Medical Association. Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis. Print Date: Source: PNC-CARR 08/16/2004 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 325 of 650 Effective Date of Service: 10/1/2004 BlueCross BlueShield of Tennessee Commercial Code Bundling Rules Comprehensive Component Code Code Source Rationale 34812 13101 BCBST Edited code not allowed when
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