Wiki NCCI Column 1 and 2 codes


Arcadia, FL
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I need help understanding my coding guide. When I look up a code, such as 67112 and in the list of NCCI Column 2 codes it has 67036 with a small "A" after it - does that mean I can bill these two codes together at the same surgery encounter, same eye, same diagnosis as long as I put a 51 modifier on it? Please help! I am so confused about these column 1 and 2 codes.

Does column 1 mean it is the first code listed on the claim form?
Where did you get your column 1/2 edits from? I downloaded the spreadsheet off CMS and I dont have any "A"s on here. What you want to look for is 1's, 0's, and 9's. 9 means there is no edit, and you can bill the two codes together with no modifier. 1 indicates a "soft edit", and that means column 2 may only be billed with column 1 on it's respective line if a modifier is used (-25 for E/Ms, -59 for others). 0 indicates a "hard edit", and column 2 may not be billed with column 1 under any circumstance.

one example of a soft edit is 95903 in column 1, and 95900 in column 2. they can be billed together, but 95900 needs -59 modifier to show the separate anatomical site required to bill these two motor NCV codes together. if they were billed together with no modifier, column 2 code would be denied.

one example of a hard edit is 92540 in column 1, and 92541 in column 2. 92541 may not be billed along with 92540 under any circumstance, as 92540 is a bundled test that includes 92541. as above, the column 2 code would be denied payment, but a modifier would not override this.

most column 1/2 edits are related to CPT guidelines ("do not report in conjunction with", "code x may be reported along with code y if separately identifiable", etc.). there is a simplified version on Supercoder if you can afford it, but otherwise you can download the spreadsheet off of CMS at the link below. be aware though the file is HUGE and wont work if you have versions prior to I think excel 10? there is a wordpad version if the spreadsheet is too big for your computer. as far as listing on the claim form I would say probably yes column 1 first, but I'm not positive. Hope I could help!! Below is the CMS link for NCCI: :)

two files, one for physician, one for hospital