Anesthesia Coding Alert

Question: I’m overwhelmed whenever I try to understand the quarterly updates from the National Correct Coding Initiative (NCCI). Can you explain what modifier indicators are and how they affect our coding?

Indiana Subscriber

Answer: Medicare releases its updates to NCCI quarterly, with the latest edition effective July 1, 2020. For your purposes, you’ll want to focus on the Medicare procedure-to-procedure (PTP) NCCI edits for practitioners.

Simply put, modifier indicators alert you to whether two procedure codes can be reported on the same claim and, if so, whether you can potentially be reimbursed for both.

In the latest NCCI edits, almost all of the additions are accompanied by a modifier indicator of 1, meaning you can unbundle the services and code them separately using one or more of the modifiers Medicare accepts for bypassing edits, such as modifier 59 (Distinct procedural service) in certain situations.

This new list of NCCI edits includes a single addition with a modifier indicator of 0, meaning you cannot unbundle this code pair for any reason.

There are also several edits that sport an indicator of 9, meaning that the edit will be deleted retroactive to its creation, as if it never existed.

Finally, remember the meaning of each column in the NCCI edits. Column 1 lists the comprehensive (or major) code, and column 2 lists the secondary (or component) code. This means that if both services are performed, the column 1 code would be payable if it’s a covered code. The column 2 code is only payable when the edit has a modifier indicator of 1 and the encounter meets the definition of distinct procedural service. Also, you must append one or more NCCI PTP-associated modifiers to bypass the edit.