The Centers for Medicare & Medicaid Services (CMS) has released the latest National Correct Coding Initiative (NCCI) update this year. Version 17.1 comprises more than 700,000 code pair edits. Amongst those NCCI edits, nearly 12,000 are new to Version 17.1. About 350 code pair edits have been removed, the majority of which are retroactive to earlier dates of service.
Retroactive code pair deletions may imply that you're entitled for payment on past claims, in case those claims were overruled based on the now-deleted code pair edits.
Version 17.1 is noteworthy for another reason: For the first time ever, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) necessitates that state Medicaid programs must include NCCI methodologies into their claims processing systems.
The objective of NCCI is to stop payments when inappropriate code combinations (unbundling) are reported. NCCI comprises two types of NCCI edits: The first of these edits are essentially the bundling edits, named "column 1/column 2" or "correct coding" edits. Codes which are listed in column 2 generally are bundled to the code listed in column 1, which is essentially the "more extensive" procedure. For instance, "CPT® code 36000 Introduction of needle or intracatheter in a vein is essential to every nuclear medicine procedure necessitating injection of a radiopharmaceutical into a vein. CPT® code 36000 is not distinctly reportable with these sorts of nuclear medicine procedures. Though, CPT® code 36000 might be reported alone in case the lone service delivered is the inclusion of a needle into a vein, as per the Correct Coding Initiative Policy Manual.
The second kind of NCCI edits, named "mutually exclusive edits," defines code pairs that will not practically be conducted at the same session along with anatomic location for the similar patient. As per the Correct Coding Initiative Policy Manual clarifies, "An instance of a mutually exclusive condition is the repair of an organ that can be carried out by two dissimilar methods. Merely one method can be selected to repair the organ. A second instance is a service that can be reported either as an ‘initial' service or a ‘subsequent' service. With the exclusion of drug administration services, the initial service along with subsequent service should not be reported at the same patient encounter."
You'll certainly want to ensure that you always refer to the most current version of NCCI when checking for code bundles. CMS updates the NCCI each quarter and posts the broad list of NCCI edits as a free download. You also may buy a subscription to NCCI, in either an electronic or a paper format, from National Technical Information Service (NTIS).
Retroactive code pair deletions may imply that you're entitled for payment on past claims, in case those claims were overruled based on the now-deleted code pair edits.
Version 17.1 is noteworthy for another reason: For the first time ever, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) necessitates that state Medicaid programs must include NCCI methodologies into their claims processing systems.
The objective of NCCI is to stop payments when inappropriate code combinations (unbundling) are reported. NCCI comprises two types of NCCI edits: The first of these edits are essentially the bundling edits, named "column 1/column 2" or "correct coding" edits. Codes which are listed in column 2 generally are bundled to the code listed in column 1, which is essentially the "more extensive" procedure. For instance, "CPT® code 36000 Introduction of needle or intracatheter in a vein is essential to every nuclear medicine procedure necessitating injection of a radiopharmaceutical into a vein. CPT® code 36000 is not distinctly reportable with these sorts of nuclear medicine procedures. Though, CPT® code 36000 might be reported alone in case the lone service delivered is the inclusion of a needle into a vein, as per the Correct Coding Initiative Policy Manual.
The second kind of NCCI edits, named "mutually exclusive edits," defines code pairs that will not practically be conducted at the same session along with anatomic location for the similar patient. As per the Correct Coding Initiative Policy Manual clarifies, "An instance of a mutually exclusive condition is the repair of an organ that can be carried out by two dissimilar methods. Merely one method can be selected to repair the organ. A second instance is a service that can be reported either as an ‘initial' service or a ‘subsequent' service. With the exclusion of drug administration services, the initial service along with subsequent service should not be reported at the same patient encounter."
You'll certainly want to ensure that you always refer to the most current version of NCCI when checking for code bundles. CMS updates the NCCI each quarter and posts the broad list of NCCI edits as a free download. You also may buy a subscription to NCCI, in either an electronic or a paper format, from National Technical Information Service (NTIS).
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