Practice Management Alert

Each quarter, you face the often-daunting task of incorporating new bundling edits from the National Correct Coding Initiative (NCCI) into your billing process.

What it means: NCCI edits are pairs of CPT or HCPCS Level II codes that Medicare (and many private payers) will not reimburse if you report  them together, except under certain circumstances. NCCI contains two types of edits: mutually exclusive 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, and column 1/column 2 edits describe -bundled- procedures.

Modifier tip: In certain circumstances, you can override NCCI edits and achieve separate reimbursement for bundled codes. Each NCCI code pair edit includes a correct coding modifier indicator of -0- or -1.- A -0- indicator means that you may not unbundle the edit combination using a modifier under any circumstances, according to NCCI guidelines. An indicator of -1- means that you may use a modifier to override the edit in special circumstances if the procedures are separate and distinct from one another.