Q&A: Mutually exclusive procedures

Q. Under what circumstances could two services be considered mutually exclusive?

A. Mutually exclusive procedures follow a specific type of edit rationale. Mutually exclusive edits are designed to prevent separate payment for procedures that cannot reasonably be performed together based on the code definition or anatomic considerations.

The NCCI Manual provides the following examples of scenarios where two services “cannot reasonably be done at the same session”:

• The repair of an organ by two different methods. One repair method must be reported for the repair.
• An initial service and a subsequent service. It is considered contradictory for a service to be classified as both an initial and a subsequent service at the same time (with the exception of drug administration services).

For more information, see Medicare Billing Edits: A Guide to Regulation, Research, and Resolution.

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