Ophthalmology and Optometry Coding Alert
NCCI Edits All Around - Free of Charge
CMS has made it easier for physicians and other providers to code properly - and be paid promptly - for their services.
On its Web site, CMS has posted the automated edits used to identify questionable claims and adjust payments to reflect what would have been paid had the claim been correctly filed. The edits, known as the National Correct Coding Initiative (NCCI), identify pairs of services that normally cannot be billed by the same physician for the same patient during the same patient encounter. The NCCI also promotes uniformity in interpreting payment policies among contracted Medicare claims processors.
NCCI is the most recent addition to a series of CMS initiatives to use the Internet to reduce the regulatory burden on physicians - and make it easier for them to work with Medicare to improve beneficiary services. Earlier this summer, CMS added the "Medicare Physician Fee Schedule Look-up" to its Web site. This tool allows physicians to determine in advance what they will be paid for a particular service or range of services.
While the NCCI is one of the cornerstones of CMS's efforts to ensure that Medicare and beneficiaries are not overcharged, CMS also believes physicians should have easy access to the edits used to identify incorrect claims.
The NCCI, previously available only on a paid subscription basis, is comprised of two sets of edits:
Comprehensive/component edits - identify code pairs that should not be billed together because one service inherently includes the other.
Mutually exclusive edits - Identify code pairs which, for clinical reasons, are unlikely to be performed on the same patient on the same day (e.g. a mutually exclusive edit might identify two different types of testing that yield equivalent results).
The NCCI edits are posted as a spreadsheet, 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, Medicare Carriers Manual, and the NCCI Question and Answer page.
The NCCI edits are posted at: http://cms.hhs.gov/
physicians/cciedits/default.asp. The Medicare Physician Fee Schedule Look-up can be found on the Physicians Resource Page: http://cms.hhs.gov/physicians/default.asp.
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