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November 2006 · Vol. 18, No. 11

REIMBURSEMENT ADVISER

Use of “complication” triggers Medicare denial

Melanie  Witt,  RN, CPC-OGS, MA

Independent coding and documentation consultant; former program manager, Department of Coding and Nomenclature, American College of Obstetricians and Gynecologists

Q

During a sling procedure for stress urinary incontinence, the surgeon accidentally knicked the bladder, which was then repaired, and a cystoscopy was also performed. These procedures were denied as included in the sling procedure. This was a Medicare patient.

A

Unfortunately, your coding ran afoul of established National Correct Coding Initiative (NCCI) bundling and general guidelines.

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