Practice Management Alert

Question: The National Correct Coding Initiative version 11.3 edits just came out, and one of our new billers is asking me a lot of questions about them. Would you give me a rundown of NCCI edit basics?


Missouri Subscriber
 

Answer: The NCCI edits are a list of CPT or HCPCS Level II codes that are not separately payable, except under certain circumstances, when performed with certain procedures. The edits found in version 11.3 took effect Oct. 1, and will be the rule until Dec. 31, 2005. Billers should check the NCCI edits when their physician provides more than one service for the same beneficiary on the same date of service. There are two types of NCCI edits: mutually exclusive edits and bundled edits.

Mutually exclusive edits are for situations in which it would be medically improbable to perform both billed procedures in the same session. When you report codes that NCCI identifies as mutually exclusive for a single treatment session, the carrier will usually reimburse only the lesser-valued procedure.

Bundled edits are code pairs consisting of one comprehensive code and one component code. NCCI considers the service represented in the component code included in the comprehensive code, and therefore the component  code is not separately billable.

Unbundle with 59: Bundled edits with a status indicator of -1- may be unbundled in certain situations using modifier 59 (Distinct procedural service). Special rules apply when you unbundle codes that the edits pair, so be sure you have the correct documentation before reporting services this way.

See for yourself: The NCCI edits are posted at http://cms.hhs.gov/physicians/cciedits/default.asp.