Wiki Ncci edit examples

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Norolyn7

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Hello everyone, I am currently studying for the CPC exam. In the study guide, a rationale for the integumentary system states that the NCCI edit example is provided in this chapter. The codes in reference are 11042 and 10060. The rationale states that a modifier indicator is listed next to the edit indicating the number of modifiers and whether modifiers are allowed. Can someone please help me with this. I have the professional edition CPT 2015 and have searched vigilantly to no avail. Thanks!:confused:
 
Many codes, such as the example bump up against each other as "component edits." NCCI stands for "National Correct Coding Initiative." There is a code pair listing on the CMS Website (cms.hhs.gov) and you can search for NCCI there. They also have more information about NCCI edits in general.
Short version:
A modifier indicator = '0' means no modifiers are allowed.
An indicator of '1' means that, if there is an appropriate modifier it may be appended.
An indicator of '9' means the edit has been deleted.

In the case of your example, 10060 is component of 11042 (that is, the 11042 includes the 10060 for the same site or lesion). So without a modifier 11042 would be paid but 10060 would not.
 
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