Get a handle on the NCCI in's and out's by reading these six questions and committing their answers to memory. Question 1: What Are NCCI Edits? National Correct Coding Initiative edits are pairs of CPT or HCPCS Level II codes that Medicare (and many private payers) will not reimburse separately except under certain circumstances. Medicare applies the edits to services billed by the same provider for the same beneficiary on the same date of service, says Kelly Dennis, MBA, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.
Example: The most recent edition of NCCI (version 12.2), effective July 1, includes an edit bundling therapeutic injection code 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) into 86580 (Skin test; tuberculosis, intradermal). This means that your ob-gyn could not report 90772 and 86580 for the same patient during the same session and expect to receive reimbursement for both procedures Question 2: What Does -Mutually Exclusive- Mean? NCCI contains two types of edits: mutually exclusive and comprehensive/component edits.
Mutually exclusive edits pair procedures or services that the physician would not reasonably perform at the same session, at the same anatomic location, on the same beneficiary, Dennis says.
Example: You-ll find that 76828 (Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study) is a component of 76820 (Doppler velocimetry, fetal; umbilical artery) and 76821 (... middle cerebral artery), thanks to an NCCI mutually exclusive edit.
If you were to report two mutually exclusive codes for the same patient during the same session, Medicare would reimburse only for the lesser valued of the two procedures. In this case, 76828 is the lesser valued procedure. Question 3: How Does -Column 1/Column 2- Differ? Comprehensive/component edits describe bundled procedures. That is, CMS considers the code listed in column 2 as the lesser service, which is included as a component of the more extensive column 1 procedure.
Example: NCCI contains an edit that bundles moderate sedation codes (99143-99149) into 58823 (Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [e.g., ovarian, pericolic]). In this case, 58823 is the more extensive procedure, which includes the lesser procedure -- any one of the moderate sedation codes (99143-99149). The moderate sedation is an inherent part of the procedure when performed by the same physician performing the procedure.
If you were to report bundled (comprehensive/component) procedures for the same patient during the same session, Medicare would reimburse only [...]