Skip to main content

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

Comments

Post a Comment

Popular posts from this blog

What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare  Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria:  Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits.  Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition ...
7 comments
Read more

Novitas Address for mailing paper claims

According to Novitas   “ Effective 04/15/2014, paper claims that were submitted to the old Novitas Solutions mailing addresses are no longer being forwarded by the postal service. The 1500 claim forms are being mailed back to the provider and will need to be resubmitted to the correct mailing address” Herewith we have enclosed the Novitas mailing address Jurisdiction H (JH) includes Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Indian Health and Tribal facilities as well as Veterans Affairs. General Mailing Address Novitas Solutions Attn: (dept or function name or specific person) 2020 Technology Parkway, Suite 100 Mechanicsburg, PA 17050 Addresses for Claims and Development Responses This section contains the addresses for submitting initial claims and responding to development requests for additional information. Part B Claims Novitas Solutions Attn: Part B Claims PO Box XXXX (replace the Xs with the PO Box number from ...
4 comments
Read more

Novitas Mailing address

General Mailing Address Novitas Solutions Attn: (dept or function name or specific person) 1800 Center Street Camp Hill, PA 17089 Addresses for Claims and Development Responses This section contains the addresses for submitting initial claims and responding to development requests for additional information. Part A Claims Novitas Solutions Attn: Part A Claims PO Box 890 XXX (replace the Xs with the PO Box number from the table below) Camp Hill, PA 17089- XXXX (fill in the +4 from the table below) Part A Claims PO Box Zip +4 Arkansas PO Box 890103 17089-0103 Colorado PO Box 890113 17089-0113 Contractor ID 12901 - PA, NJ, MD, DC, DE PO Box 890122 17089-0122 Delaware PO Box 890417 17089-0417 Louisiana PO Box 890103 17089-0103 MD/DC PO Box 890385 17089-0385 ...
4 comments
Read more