Certified Coding Associate (CCA) Practice Exam

Medicare typically follows the National Correct Coding Initiative (NCCI) edits to regulate appropriate billing practices. When a catheter placement is billed alongside an infusion procedure, specific coding rules apply.

In this scenario, the correct answer focuses on payment for the infusion procedure. The reason for this is that when both procedures are performed together, the infusion is often considered a more comprehensive service. According to NCCI guidelines, the catheter placement is generally considered a component of the infusion, and therefore, only the more complex procedure, which is the infusion, is eligible for payment.

The reasoning aligns with the NCCI edits that aim to prevent duplicative payments for procedures where one service is inherently part of the other. Therefore, while the catheter placement is necessary for the infusion to occur, it does not get billed separately for payment purposes, as it is typically bundled into the infusion procedure payment.

This is a common situation in clinical coding, emphasizing the importance of understanding NCCI edits and how they affect reimbursement decisions.