Wiki NCCI edit code 9

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Mrsrpc

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ISO practical information re: NCCI edit code 9. In training course, it states that 9= "code edit not specified," and that "this means that an NCCI edit does not apply" and "that an NCCI edit does not apply to this PTP code pair. The PTP code pair was deleted retroactively." Neither of these have much meaning to me in terms of what to actually DO with this information when billing. For example, does it mean that the pair is free from the constraints of the PTP pair not being allowed to be reported/billed together? Does it mean that it is not allowed now, but once was? Does it mean that it is NOW allowed, but once was not bc it was deleted retroactively? What am I missing? It reads like an unfinished sentence, but maybe i'm lost in the weeds....
 
Mrsrpc said:
ISO practical information re: NCCI edit code 9. In training course, it states that 9= "code edit not specified," and that "this means that an NCCI edit does not apply" and "that an NCCI edit does not apply to this PTP code pair. The PTP code pair was deleted retroactively." Neither of these have much meaning to me in terms of what to actually DO with this information when billing. For example, does it mean that the pair is free from the constraints of the PTP pair not being allowed to be reported/billed together? Does it mean that it is not allowed now, but once was? Does it mean that it is NOW allowed, but once was not bc it was deleted retroactively? What am I missing? It reads like an unfinished sentence, but maybe i'm lost in the weeds....
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It means there is no PTP edit for the code. You don't have to do anything special when billing that code pair, because an edit doesn't exist.

(It's on the list because at one point they tried to implement a code edit for the pair, and it was deleted as if it never existed. Maybe providers protested the edit with proof that it was invalid, or information became available in some other way to show that the edit shouldn't have been put in place. So you can proceed as if an edit never existed for the code pair and disregard completely.)
 
sls314 said:
It means there is no PTP edit for the code. You don't have to do anything special when billing that code pair, because an edit doesn't exist.

(It's on the list because at one point they tried to implement a code edit for the pair, and it was deleted as if it never existed. Maybe providers protested the edit with proof that it was invalid, or information became available in some other way to show that the edit shouldn't have been put in place. So you can proceed as if an edit never existed for the code pair and disregard completely.)
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So it's almost like a code 1 (allowed unless prohibited by another regulation) but it has a history that needed to be clarified? Go ahead and bill both codes?
 
Mrsrpc said:
So it's almost like a code 1 (allowed unless prohibited by another regulation) but it has a history that needed to be clarified? Go ahead and bill both codes?
Click to expand...
No, a code 1 means that the two codes are regularly not billed together. If they are truly separate and identifiable, a modifier is allowed to be appended in order to submit them together. A 9 code means that there is no edit in place. It was once suggested and basically after comments were received during the commenting period that is before the edits go into effect, it was removed from the edits being put into place at that time.
 
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