Wiki NCCI Understanding Help

[ErinPDX85]

Hello!

I was just hoping for some general help in understanding how the NCCI edits work. I am grasping it much better than before, but I do have (hopefully) one last area that is giving me confusion.

My scenario - a kiddo comes in for their annual wellness check (99394). They're 13, receive a shot (let's say flu, with admin code 90460), have a CRAFFT (96160) and PHQ 9 screener, (96127) and a vision screening (99173). These codes all have tons of NCCI edits as follows:

96160 (column 1) and 99173 (column 2) allowed to override
96127 (column 1) and 96160 (column 2) allowed to override
90460 (column 1) and 96160 (column 2) allowed to override
90460 (column 1) and 99394 (column 2) allowed to override

So! Which of these two ways is the correct way to code? My main question comes down to if it is correct to have a modifier 59 on both the 99173 and 96160.

99394 - 25
96160 - 59
96127
flu shot code
90460
99173 - 59

or

99394 - 25
96160 - 59
96127
flu shot code
90460
99173

Thanks so much!
Erin

 

[cgaston]

This should be a useful reference:
https://www.cms.gov/Outreach-and-Ed...NProducts/Downloads/How-To-Use-NCCI-Tools.pdf

 

[ErinPDX85]

Thank you for the link - unfortunately I have read that before and it didn't answer my question (or perhaps it did, but it is just not clicking for me )