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Thread: NCCI Edits...

  1. #1
    Join Date
    Apr 2007
    First Hill, Seattle WA

    Default NCCI Edits...

    AAPC: Back to School
    Increasingly more and more commerical payors are adopting the NCCI edts. My question as to do with a code pair with a "0" indicator--meaning these two codes will not be reimbursed. My question is this, if we know in advance that one of the codes will not be covered, do we bill for it anyway (and get the denial) or do we not bill for the one that won't be covered?

    Thanks for any insight regarding this!


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    I have read that when a code pair is bundled or mutually exclusive and no modifier is allowed, then you should bill the procedure with the highest RVU and drop the other. Otherwise many payers will pay only the lowest, and they are instructed to do that.

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