Wiki NCCI ? Anyone familiar with this ?

[somountain@aol.com]

Our billing company informed me to become familiar with NCCI. I went on CMS Website and read the manual about the indicator columns... They mentioned a manual AND before I jump into this - IS THIS NECESSARY? Our field is Orthopaedic Surgery. Thank you.

 

[ridenut]

The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct
coding methodologies and to control improper coding leading to inappropriate payment. NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together.

In addition to code pair edits, the NCCI includes a set of edits known as Medically Unlikely Edits (MUEs). An MUE is a maximum number of Units of Service (UOS) allowable under most circumstances for a single Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) code billed by a provider on a date of service for a single beneficiary.

Here is a guide you should read:

http://www.cms.gov/Outreach-and-Edu...NProducts/Downloads/How-To-Use-NCCI-Tools.pdf

Most helpful coding programs like Encoder Pro has a built in tool so you can plug in the codes and see if any edits exsist.

Nicole

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[ollielooya]

In addition to what the first responder posted, and to answer your question, YES, it is absolutely necessary especially in regards to Orthopaedic Surgery. It is an essential component to MCR billing which affects other carriers as well that follow the MCR guidelines. Pay heed to what Nicole posted to you, and dig in and learn. You can use what is available thru thru CMS, or you might want to purchase online program or software to aid in its use. That's what we did and makes our job a whole lot easier!

 

[Lynda Wetter]

In my opinion it is needed in every practice regardless of specialty. Even if you do not routine bill codes that bundle, you should know what they are and how to look them up. They are crucial for correct modifier usage in a lot of cases.