Gastroenterology Coding Alert

Remember to look out for No. 1

The National Correct Coding Initiative (NCCI) released it version 11.0 edits, effective Jan. 1, 2005. For more information, you can head to your computer and check out the newest NCCI edits online.
 
How? Visit the NCCI edits on the World Wide Web at www.cms.hhs.gov/physicians/cciedits/default.asp. The edits are in spreadsheet form, allowing users to sort by procedural code or effective date.
 
The new Web page also includes links to documents that explain the edits, the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and the NCCI Question and Answer page.

Don't Forget: '1' Is the Most Important Edit Number

When you peruse the NCCI site, remember that there are two types of edits: mutually exclusive edits and
"column 1/column 2" (previously known as "comprehensive/component" edits).
 
Mutually exclusive edits pair procedures or services that the physician could not reasonably perform at the same session on the same beneficiary, says Kelly Dennis, CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. The new edits include codes in column 2 that carriers bundle into the codes in column 1. These are nonmutually exclusive codes with a "1" in the modifier column.
 
Exception: An indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another. This means that if the procedure in column 1 occurs at a different location than the procedure in column 2, you may report the services independently with modifier -59 (Distinct procedural service) appended.