Version 12.2 Update:
Your Top 6 NCCI Questions Answered
Published on Thu Jul 20, 2006
Make a note of the one cardiology-related deletion If you're still uncertain what a mutually exclusive edit is and whether you're using the latest NCCI version in your cardiology practice, you could be setting yourself up for possible future reimbursement hassles.
Get a handle on the NCCI ins and outs by reading these six questions and the answers that our experts provided. Question 1: What Are NCCI Edits? National Correct Coding Initiative (NCCI) 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 service date, 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, bundles 75960 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel) into 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation). This means that your cardiologist may not be able to collect if he bills both 75960 and 75894 for the same patient on the same day. 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: Prior to July 1, you were not able to report critical care codes 99291-99292 when your cardiologist provided this service on the same that he reported 99239 (Hospital discharge day management; more than 30 minutes), thanks to a mutually exclusive edit.
If you were to report two mutually exclusive codes for the same patient during the same session, often the pairings are such that payers would pay for the procedure in the left-hand column (in this case 99239) and deny the payment for the service in the right-hand column (codes 99291 and 99292). Due to these problematic edits, payers would reimburse the less expensive service because they include all E/M services provided on the day of discharge in the discharge day management codes.
Update: NCCI 12.2 now deletes this mutually exclusive edit, so as of July 1, you no longer have to worry about reporting 99291-99292 and 99239 on the same day. Question 3: Do 'Column 1/Column 2' Edits Differ? Comprehensive/component edits describe bundled procedures/services. 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 service.
Example: NCCI 12.2 bundles 93040 (Rhythm ECG, one to [...]
