Neurology & Pain Management Coding Alert

Question: I know a bit about the National Correct Coding Initiative (NCCI) quarterly edits. However, I don’t feel like I’m caught up as I haven’t consulted NCCI for a year or more. Can you give me a quick rundown about the latest edits, along with a refresher on some of the major NCCI concepts?

Florida Subscriber

Answer: The Medicare National Correct Coding Initiative (NCCI) just released its latest quarterly updates, with an effective date of July 1, 2020. For your purposes, you’ll want to focus on the Medicare Procedure-to-Procedure (PTP) NCCI edits for practitioners.

As there are hundreds of additions/deletions in the update, it would be impossible to delve into the specifics of each edit. Coders should check out the list themselves; then, check the list against the codes you use in your work, and make any necessary adjustments. The NCCI edits are at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes. Scroll down to “Quarterly Additions, Deletions, and Modifier Indicator Changes to NCCI PTP Edits for Physicians Practitioners Effective July 1, 2020-posted June 1, 2020,” and download the file.

It’s also important to make sure that the NCCI edits have been implemented by payers before you file using the new edit rules. The implementation date is officially July 1, but not every payer is right on time with every update. According to Medlearn Matters, the NCCI effective date is July 1, but the implementation date when payers have to have systems ready is July 6.

Modifier indicators: Another concept you need to grasp when reading NCCI edits is that of modifier indicators. 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 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.