ncci edits column 1 and 2

Can someone explain to me about column 1 and column 2 in the ncci edits. I tried to look it over and get it from cms but I do not get it. please help

amatoj16 said:

Can someone explain to me about column 1 and column 2 in the ncci edits. I tried to look it over and get it from cms but I do not get it. please help

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The code in Column 1 is the code that can be billed. The code in Column 2 is the one that would be bundled and not paid. (Unless the code pair allows a modifier, and the Column 2 code truly was a separate procedure.)

For example, the code pair 11042 (debridement) and 29105 (application of a long arm split) would hit an NCCI edit.

11042 is the Column 1 code - it would be the payable code if both CPTs were billed together.

29105 is the Column 2 code that would be bundled. However, a modifier is allowable. If it was a distinct service, then the edit can be overridden and 29105 could also be payable with 11042.

If the debridement was performed on the leg and the patient also needed a splint on the arm, it would be appropriate to use a modifier to override the edit to show that the services were separate.

If the debridement was performed on the same arm that was splinted, you would only be paid for the debridement.

That makes so much sense. by any chance to do you have a copy of the ncci edits with column 1 and 2 that you could email me?

The edits are updated quarterly. They are posted on the CMS website, but in my opinion, the CMS access is not particularly user friendly. Most people I know have some type of coding software they use to simply plug in the codes and find out if they are edits. Some billing systems will also have the NCCI edits downloaded and alert you as codes are entered (or in an overnight edit run).
If you don't have coding software (I do recommend it for NCCI edits and a host of other reasons) or your billing system does not have NCCI edits, there may be other free online tools from local MACs that are more user friendly than CMS's.

I tried to get it from CMS website and your correct it is horrible to read. I have nextgen billing software and i doubt they have ncci edits downloaded but i will call and ask them. The free tools can be downloaded into the computer? Thank you for your help I really appreciate your help. I worked in bariatric office before coming to a foot and ankle surgeons and i find it more difficult billing for Foot and ankle then any other part of the body. lol

In regards to NextGen, there is an option to turn on the RTE Claim Edits, which will trigger for CCI bundling issues. Your system administrator or whomever has access to File Maintenance in your practice should be able to check your Claim Edit Library/Libraries to see if these are already turned on. However, you're not going to get the level of details provided in the example above. You still must refer to the actual CCI file, whether it's the version from CMS or you get them through an Encoder subscription.

is the RTE Claims edit a third party billing? because they don't know what i am taking about when i called Nextgen. Do you know where i could look for it? I would really appreciate it

No, it's a separate area within NextGen but you do need an RTE license (to the best of my knowledge) if you haven't purchased one. Your NextGen administrator should be able to look at the Practice in File Maintenance. If you've purchased an RTE license as part of your contract, it should be checkmarked in the Practice Licensing area of the window.

Your best option may be to find out who your Account Manager is and ask them to help guide you. Alternatively, if someone in your office has the ability to open a case on the NextGen Success Community, use the Ambulatory EDI category then the Real Time Edits topic. If you don't have access to the website, you should be able to do the same thing by calling in to open a support case.

Why is codify showing 22867 in column 2 and 63047 in column 1 and placing the modifier on 22867? The claim should be 22867, 63047 modifier XS 63048 - decompression L3-L4 L4-L5 L5S1 my biller is adding the 59 to 22867 and I am trying explain to her that 22876 is in column 1 as it is the higher value CPT

bbrandi said:

Why is codify showing 22867 in column 2 and 63047 in column 1 and placing the modifier on 22867? The claim should be 22867, 63047 modifier XS 63048 - decompression L3-L4 L4-L5 L5S1 my biller is adding the 59 to 22867 and I am trying explain to her that 22876 is in column 1 as it is the higher value CPT

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63047 is the primary code in the edit.

22867 is the Column 2 code that would need a modifer, if appropriate.


By the way, the NCCI edits aren't only determined by RVU alone. But in this case...63047 does have the higher RVU anyhow.

63047 has 31.9 total RVU.
22867 has 30.3 total RVU.

You can look at the source PTP edits on the CMS website, if you'd like: https://www.cms.gov/medicare/coding...s/medicare-ncci-procedure-procedure-ptp-edits

sls314 said:

63047 is the primary code in the edit.

22867 is the Column 2 code that would need a modifer, if appropriate.


By the way, the NCCI edits aren't only determined by RVU alone. But in this case...63047 does have the higher RVU anyhow.

63047 has 31.9 total RVU.
22867 has 30.3 total RVU.

You can look at the source PTP edits on the CMS website, if you'd like: https://www.cms.gov/medicare/coding...s/medicare-ncci-procedure-procedure-ptp-edits

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My claims are being denied. we have billed with 22867 59 63047 63048 they are paying the 22867 and denying the 63047 adn 63408