Don't Ask; Check NCCI

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  • November 29, 2010
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Checking the National Correct Coding Initiative (NCCI) website regularly for allowable code combinations helps eliminate questions like the following, asked at the Oct. 6 NHIC, Corp. Mental Health Services Virtual Room/Teleconference:
“Can CPT 90862 be provided on the same day as individual therapy?”

Check the Policy

A quick look at chapter 11 of the NCCI Policy Manual for Medicare Services tells you:
“Drug management is included in diagnostic and therapeutic psychiatric services (e.g., CPT codes 90801-90829, 90845, 90847-90853, 90865-90880). CPT code 90862 and HCPCS [Level II] code M0064 (pharmacologic management) are not separately reportable with these codes. Both CPT code 90862 and HCPCS code M0064 require face-to-face patient contact by the practitioner licensed to perform the service. Facilities may report CPT code 90862 or HCPCS code M0064 (pharmacologic management services) with a psychotherapy code if the two services are performed at separate patient encounters on the same date of service.”

Check the NCCI Edits

Another place you can look is in the NCCI Table of Edits, the Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table. These tables include code pairs that should not be reported together for a number of reasons explained in the NCCI Policy Manual for Medicare Services. In the modifier indicator column, the indicator 0 (not allowed), 1 (allowed), or 9 (n/a) shows whether an NCCI-associated modifier may be used to bypass a code pair edit.
NCCI-associated modifiers, such as Modifier 59 Distinct procedural service, should not be used to bypass an NCCI edit unless the proper criteria for use is met and documented in the medical record. For example, to use modifier 59 to bypass an NCCI edit, the medical record must document that the two procedures were performed at different anatomic sites or different patient encounters on the same date of service.
The CMS article “Proper Usage Regarding Distinct Procedural Service” further explains the proper use of Modifier 59.

Check Often

Quarterly updates to NCCI edits are available on the Centers for Medicare & Medicaid Services (CMS) Data Center website. For physicians, CMS most recently released NCCI version 17.0, effective Jan. 1, 2011. Version 16.3 is effective Oct. 1 through Dec. 31.
It’s important to remember, however, that NCCI edits and policies do not include all possible combinations of correct coding edits or types of unbundling that exist. When in doubt, consult your Medicare payer for specific guidelines.

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