NCCI v17.1 Includes Thousands of New Edits

The Centers for Medicare & Medicaid Services (CMS) has released the latest National Correct Coding Initiative (NCCI) update. Version 17.1 is effective April 1, and contains more than 700,000 code pair edits. Among those edits, nearly 12,000 are new to Version 17.1. Approximately 350 code pair edits have been deleted, the majority of which are retroactive to earlier dates of service.

Action point: Retroactive code pair deletions may mean you’re eligible for payment on past claims, if those claims were rejected based on the now-deleted code pair edits.

Version 17.1 is significant for another reason: For the first time, Medicaid payers will have to observe NCCI edits. The Patient Protection and Affordable Care Act (H.R. 3590, section 65607) requires state Medicaid programs to incorporate NCCI methodologies into their claims processing systems by April 1.

The purpose of NCCI is to prevent payments when incorrect code combinations (unbundling) are reported. NCCI contains two kinds of edits: The first of these are the bundling edits, called “column 1/column 2” or “correct coding” edits. Codes listed in column 2 normally are bundled to the code listed in column 1, which is the “more extensive” procedure. For example, “CPT® code 36000 Introduction of needle or intracatheter into a vein is integral to all nuclear medicine procedures requiring injection of a radiopharmaceutical into a vein. CPT® code 36000 is not separately reportable with these types of nuclear medicine procedures. However, CPT® code 36000 may be reported alone if the only service provided is the introduction of a needle into a vein,” according to the Correct Coding Initiative Policy Manual.

The second type of edits, called “mutually exclusive edits,” describes code pairs that would not reasonably be performed at the same session and anatomic location for the same patient. As the Correct Coding Initiative Policy Manual explains, “An example of a mutually exclusive situation is the repair of an organ that can be performed by two different methods. Only one method can be chosen to repair the organ. A second example is a service that can be reported as an ‘initial’ service or a ‘subsequent’ service. With the exception of drug administration services, the initial service and subsequent service cannot be reported at the same patient encounter.”

You’ll want to be sure that you always refer to the most up-to-date version of NCCI when checking for code bundles. CMS updates the NCCI each quarter (Jan. 1, April 1, etc.), and posts the complete list of edits as a free download. You also may purchase a subscription to NCCI, in electronic or paper format, from National Technical Information Service (NTIS).

Source: MLN Matters article MM7331


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2 Responses to “NCCI v17.1 Includes Thousands of New Edits”

  1. Bai Margolin says:

    Will Medicaid then accept the 59 modifier? It’s not accepted here in MA. I’ve only heard that MassHealth now accepts the global surgery modifiers (they didn’t for all the years I’ve been a coder).

  2. Kathy Evans says:

    In Georgia they will not accept the 59 modifier thus causing more appeals. Kathy

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