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NCCI


NCCI Edit, CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the AMA CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the NCCI Coding Policy Manual for Medicare Services (Coding Policy Manual).  The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.
Carriers implemented NCCI edits within their claim processing systems for dates of service on or after January 1, 1996.

 NCCI edit & modifier indicator:
 
1)      “0” modifier means unable to override the edit
2)      "1" means correctly coded and use of modifier 59 can be used to allow submitted services or procedures.
 
Many procedures we cannot code together because they are mutually exclusive
NCCI Edits allows overrides of some edits with the indicator “1” added with use of the appropriate modifier. The following modifiers are allowed with the CCI edits:

Anatomical Modifiers         Global Surgery Modifier        Other Modifiers    
E1     -F6     -T1                           -25         -78                        -59  
E2     -F7     -T2                           -58         -79                        -91  
E3     -F8     -T3                   
E4     -F9     -T4                   
-FA    -LC     -T5                                    
-F1    -LD     -T6                    
-F2    -RC     -T7                  
-F3    -LT      -T8                   
-F4    -RT      -T9                  
-F5    -TA                         

Bypasses on Mutually Exclusive Edits or Correct Coding Edits, append the correct modifier to the code that appears in Column 2 which is the “Bundled” procedure.

Additionally in order to assign the correct modifier and bypass an edit it is of the utmost importance that the billing person understands and meets the conditions of that modifier

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