What You Should Know About National Correct Coding Initiatives (NCCI) Edits

The National Correct Coding Initiative (NCCI) consists of codes that have paired edits. When the two codes are billed together the edits are in place to prevent improper payment for claims submitted together for Part B services. CMS has developed NCCI edits-physicians, NCCI edits-outpatient, and Medically Unlikely Edits (MUE) to help protect the Medicare Trust Fund. When a Medicare contractor receives two paired codes that are on either the NCCI or MUE tables, the column 1 code will process as normal, but the column 2 code will deny. Majority of the time the column 2 code is a component of the column 1 code. Occasionally, both services maybe medically necessary, in which the modifier indicator will notate 1, the provider must submit the appropriate m modifier notifying the contractor the services are separate identifiable procedures. NCCI modifiers to keep in mind when billing paired NCCI codes: “25” ñ Significant, separate E & M service on same day as a procedure “59” ñ Distinct procedural service “58” ñ Staged or related procedures “78” ñ Return to the OR for a related procedure during the post-operative period “79” ñ Unrelated procedure by the same physician during the postoperative procedure “91” ñ Repeat lab test

Source: https://www.cgsmedicare.com/