Inquiries about the NCCI program, including those related to NCCI (PTP, MUE and Add-On Code) edits, should be sent to the following
email address:
[email protected]
. The NCCI contractor is able to address questions and concerns about NCCI edits and the program in general.
How do I check my NCCI edits?
The NCCI Policy Manual, MUEs, and PTP edits are accessed
through the NCCI Edits webpage
. Links to the PTP Coding Edits, Medically Unlikely Edits, and NCCI manual webpages are provided in the menu on the left side of the NCCI Edits webpage.
Do all payers follow NCCI edits?
Technically, the NCCI edits only apply to Medicare fee-for-service, but
the majority of commercial payers do use the NCCI edits in their systems
, so there’s a good chance you’ll need to comply with the edits even if you aren’t working with Medicare.
What is NCCI PTP edits?
NCCI Procedure-to-Procedure (PTP) edits are
code pair edits that prevent improper payment when certain codes are submitted together
. CMS defines modifiers that may be used under appropriate clinical. circumstances to bypass certain NCCI PTP edits.
Can claims be denied due to NCCI edits?
A:
There is no claim
processing system override for NCCI edits. Claims that fail the NCCI edits will be denied and returned to the provider, who may submit an appeal for reconsideration of payment in excess of the normally allowed amount.
What does 9 mean on NCCI edits?
9 – A “9” indicator is used
for all code pairs whose deletion date is the same as their effective date
. In other words, these edits are no longer active, so the code combinations are billable, and no modifier is needed.
What is a 59 modifier?
CPT modifier 59 is used to
identify procedures/services
, other than E/M services, that are not normally reported together but are appropriate under the circumstances.
Which modifier will not bypass the NCCI edits?
A modifier
indicator of “0”
indicates that an edit can never be bypassed even if a modifier is used. In other words, the Column 2 code of the edit will be denied.
What does Mue of 2 mean?
MUE edits with an MUE Adjudication Indicator (MAI) of “2” (Date of Service Edit: Policy): a. The MUE value is an absolute date of service limit that may not be overridden or bypassed with a modifier. b. MUE edit limits with an MAI of “2” have been rigorously reviewed and vetted within CMS.
Can 97110 and 97112 be billed together?
24 minutes of neuromuscular reeducation, code 97112, 23 minutes of therapeutic exercise, code 97110, … than 15 minutes, so each
shall be billed for at least 1 unit
. The correct coding is 2 units of code 97112 and one unit of code 97110, assigning more timed units to the service that took the most time.
What are iCES edits?
iCES is a
state-of-the-art claims editing system that evaluates billing information and coding accuracy on submitted claims using an automated process
. … Although the WIT will not provide eligibility, benefit or reimbursement information, it will allow access to the coding rationale regarding claims payments.
What are CCI edits?
CCI Edits. The NCCI is
an automated edit system to control specific Current Procedural Terminology (CPT® American Medical Association)
code pairs that can or cannot be billed by an individual provider on the same day for the same patient (commonly known as CCI edits).
What are OCE edits?
The Outpatient Code Editor (OCE) is an editing system created and maintained by CMS to process outpatient facility claims. The OCE edits
identify incorrect and inappropriate coding of these claims
.
How often are NCCI edits updated?
Remember that NCCI tables are updated
quarterly
and saved tables must be replaced in order to have the most current information. We will demonstrate how to use the PTP code pair tables, using code 99215 and two of the four Practitioner PTP Edits tables as our examples.
What is the purpose of medically unlikely edits?
Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs,
to reduce the improper payment rate for Part B claims
.
What is a 24 modifier?
Modifier 24 is defined as an
unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period
. Medicare defines same physician as physicians in the same group practice who are of the same specialty.
