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NCCI edits-I have a CPT

  1. #1
    Location
    Spokane, WA
    Posts
    35
    Question NCCI edits-I have a CPT
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    I have a CPT paring of 62311 (epidural injection into the lumbar spine) and 20552 (trigger point injection, 1-2 muscle groups) being performed on the same day by the same physician.

    When I look up the NCCI edits, it states : 62311 is a component of column 1 code 20552 and cannot be billed using any modifier.

    In this instance, the "component" code has a higher RVU than the column 1 code. Am I required to bill the column 1 code due to the status indicator "0" or can I bill the column 2 code alone so that the physician gets credit for the higher listed RVU procedure? It appears that NCCI is trying to discourage the performance of these two types of procedures on the same day.

    Thanks for your help.
    T

  2. #2
    Default
    Ttate,

    This edit just became effective 4/1/09. And yes, crazy as it is, you are correct per current NCCI instruction, you would bill the 20552 only. This edit is probably why we have been seeing more posts regarding TPI denials.

    This edit does not make sense as, while I have seen them billed during the same session, they are very different procedures treating very different diagnosis and usually different body areas.

    I am going to and encourage others to send a letter or comment of dispute to the NCCI and hopefully we can get it overturned. The contact information is available on the NCCI Overview page.

    Thank you for bring this to our attention.

    Julie, CPC

  3. Default where do you look up the ncci edits?
    Where do you look up NCCI edits? We have just encountered this and we have had no help from the insurance companies as to were we can find information/protocols. thanks.


    Quote Originally Posted by ttate View Post

    I have a CPT paring of 62311 (epidural injection into the lumbar spine) and 20552 (trigger point injection, 1-2 muscle groups) being performed on the same day by the same physician.

    When I look up the NCCI edits, it states : 62311 is a component of column 1 code 20552 and cannot be billed using any modifier.

    In this instance, the "component" code has a higher RVU than the column 1 code. Am I required to bill the column 1 code due to the status indicator "0" or can I bill the column 2 code alone so that the physician gets credit for the higher listed RVU procedure? It appears that NCCI is trying to discourage the performance of these two types of procedures on the same day.

    Thanks for your help.

  4. #4
    Default
    It's available on the CMS website. Here's the NCCI edits link for physician services:

    http://www.cms.hhs.gov/NationalCorre....asp#TopOfPage

    Julie, CPC

  5. #5
    Smile NCCI edit
    Hi
    Do you know a good softwear or web base program that can be use for this Edits. We use to work with Correct Code Check but we don't have it anymore and I'm looking for a new one.
    thanks.
    Camilo Herrera CPC

  6. #6
    Location
    Spokane, WA
    Posts
    35
    Wink
    This is what I found on a quick look up... Kind of lengthy but the link is listed at the end. (I also use CodeCorrect so I haven't used this site.)

    CMS POSTS CORRECT CODING INITIATIVE EDITS ON INTERNET

    The Centers for Medicare & Medicaid Services (CMS) today made it easier for physicians and other providers to bill properly and be paid promptly for their services to people with Medicare coverage. CMS has posted on its Website the automated edits used to identify questionable claims and adjust payments to reflect what would have been paid if the claim had been filed correctly. The edits, known as the National Correct Coding Initiative (NCCI), identify pairs of services that normally should not be billed by the same physician for the same patient on the same day. The NCCI also promotes uniformity among the contractors that process Medicare claims in interpreting Medicare payment policies.

    The posting of the NCCI is the most recent in a series of steps CMS has taken to use the Internet creatively to reduce the regulatory burden on physicians and make it easier for them to work with Medicare to improve services to beneficiaries. Earlier this summer, CMS added a feature to its Website that makes it possible for physicians to determine in advance what they will be paid for a particular service or range of services. The Medicare Physician Fee Schedule Look-up provides both the unadjusted payment rates, as well as the payment rates by geographic location.

    While the NCCI is one of the cornerstones of CMS's efforts to ensure that Medicare and beneficiaries do not pay twice for the same service or for duplicative services, CMS believes physicians should have easy access to the edits CMS uses to identify incorrect claims.

    The NCCI includes two types of edits. One set– the comprehensive/component edits - identifies code pairs that should not be billed together because one service inherently includes the other. The other – the mutually exclusive edits – identifies code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results.

    Until today, the NCCI edits have been available to physicians and other providers on a paid subscription basis, but now they are available to anyone with a personal computer.

    The NCCI edits will be posted as a spreadsheet that will allow users to sort by procedural code and by effective date. A "Find" feature will allow users to look for a specific code. The edit files are indexed by procedural code ranges for easy navigation. The new Web page also includes links to documents that explain the edits: the NCCI Policy Manual for Part B Medicare Carriers, Medicare Carriers Manual, and the NCCI Question and Answer page.

    CMS developed the NCCI to promote national correct coding by physicians and oth er providers and to ensure appropriate payments for Medicare services. The coding policies developed are based on coding conventions defined in the American Medical Association's CPT (Current Procedural Terminology) manual, national and local policies and edits, coding guidelines developed by national medical specialty societies, analysis of standard medical and surgical practice and review of current coding practice. The NCCI is updated quarterly.

    The NCCI edits are posted at http://cms.hhs.gov/physicians/cciedits/default.asp.

    . The Medicare Physician Fee Schedule Look-up can be found on the Physicians Resource Page, http://cms.hhs.gov/physicians/default.asp.
    T

  7. #7
    Default
    Quote Originally Posted by cherrera26 View Post
    Hi
    Do you know a good softwear or web base program that can be use for this Edits. We use to work with Correct Code Check but we don't have it anymore and I'm looking for a new one.
    thanks.
    Hi Camilo, we use 3M coding software here and it is pretty good for edits. There are also many, many other choice softwares. Good luck

  8. #8
    Location
    Seattle First Hill
    Posts
    126
    Default
    We use Custom Coder and I think it's great. It has forums as well as a library. Plus, they have pictures on different codes which is great if you're a visual person, like I am

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by kjstearns View Post
    We use Custom Coder and I think it's great. It has forums as well as a library. Plus, they have pictures on different codes which is great if you're a visual person, like I am
    Hey! We do too...I'm curious. Does your software rank the procedures by Work RVU's or Non-facility? I'm having some issues with Custom Coders ranking method...

  10. #10
    Default
    Quote Originally Posted by kjstearns View Post
    We use Custom Coder and I think it's great. It has forums as well as a library. Plus, they have pictures on different codes which is great if you're a visual person, like I am
    Wow, that sounds good, as I am like the visual assistance as well. Maybe I'll look into that myself. Thanks

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