Many edits in the mutually exclusive edit table allow the use of ncci. If a wound care professional reports the 2 codes of an ncci edit pair for the same beneficiary on. Ncci proceduretoprocedure edits and medically unlikely edits mues. Edit mue was added to the quarterly medicaid national correct coding initiative ncci edit files that are posted on the medicaid. Medicare coding edits new and old pubmed central pmc. Understanding cci mutually exclusive designationis critical. If theres an n, then you should not bill the code in combination with the code in column 1. The presence of a hcpcscpt code in a proceduretoprocedure ptp edit or a medically unlikely edits mues value for a hcpcscpt code does not necessarily indicate that.
Ncci edits define when two procedure hcpcscpt codes may not be. The ncci contains one table of edits for physicianspractitioners and one table of edits for outpatient hospital services. National correct coding initiative edits webpage on the cms website. Ncci edits prevent improper payment when incorrect code combinations. However, you can never bill 97124 with 97140and you cannot add any modifier to change this restriction, because these codes are mutually exclusive procedures, according to cms. Ncci manual and edits may be downloaded from the cms website. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results, or two or more procedures that are not usually performed during the same patient encounter. Last month, eyenet provided an overview of the national correct coding initiative ncci, explaining that cms lists pairs of services that should not be billed together when performed by the same provider on the same patient on the same day. The columns 1 and 2 correct coding edits table and the mutually exclusive edits table include code pairs that should not be reported together for a number of reasons explained in the national correct coding initiative coding. Ncci code pairs must match on member, provider, and date of service. Each code pair column 1column 2 correct coding edits and mutually exclusive code edits is assigned a correct coding modifier indicator of 0, 1 or 9. Cms publishes the national correct coding initiative coding policy manual for. The column onecolumn two correct coding edits table and the mutually exclusive edits.
Revisions were made in chapter viii section d ophthalmology, chapter ix, section e nuclear medicine, section f radiation oncology and chapter x, section a introduction, section f molecular pathology. Do you know how to read and properly interpret the national. The ptp code pair edits, mue tables, and ncci manual are accessed. Cms has additional information about how to use ncci edits. The health plan administers unbundling edits based on the centers for medicare and medicaid services cms national correct coding initiative ncci. Mue is related to the number of units billed on a single date of service of the same code. We found that, overall, the medicare carriers applied cci edits. The ptp code pair edits, mue tables, and ncci manual are accessed through the national correct coding initiative edits. Icn 9046 january 2019 using the ncci tools looking up ptp code pair edits the first step in looking up an edit is to click the ptp coding edits link in the menu on the left side of the. April 1, 2018 includes 2018 hcpcscpt codes current procedural terminology cpt codes, descriptions and other data only are 2017. The complete updated medicaid national correct coding initiative ncci edit files are posted here at the beginning of each calendar quarter. However, on april 1, 2012, the edits in the mutually exclusive edit table were moved to the column onecolumn two correct coding edit table so that all the ncci ptp edits are currently contained in this single table. Mutually exclusive edits identify code pairs that medicare has determined are unlikely to be performed on the same patient on the same day.
National correct coding initiative policy manual for medicare. Mue edits are focused on practitioners, durable medical equipment dme suppliers and outpatient facilities. The edits are in place to prevent codes that should not be reported together from being reported. National correct coding initiative edits ncci noridian. Medicare part b mutually exclusive procedure codes. Review of medicare part b mutually exclusive procedure codes. Ncci edits were developed to prevent improper payments when incorrect code combinations are reported.
Mutually exclusive procedures are two procedures that could not have been performed during the same patient encounter because of anatomic, temporal or gender considerations. Mutually exclusive is a ptp edit, where one procedure is considered a component of a more comprehensive code. Other edits can be paid separately in certain circumstances, a process known as unbundling. These edits are further defined as proceduretoprocedure ptp code pair edits. The cms developed its coding policies based on coding conventions defined in the. Unlike the other ptp edit rationales, with mutually exclusive edits, the more. Update facilities are billing and being reimbursed for procedures that are mutually exclusive and defined by the national correct coding initiative ncci as an incorrect code combination. Each edit has a column one and column two hcpcscpt code. National correct coding initiative ncci and medically.
Mutually exclusive procedures are those procedures that cannot reasonably be performed together based on the code definitions or anatomic considerations. Column 7 provides the ptp edit rationale for each ncci edit, for example, standards of medicalsurgical practice, cpt manual or cms manual coding instructions, mutually exclusive procedures, misuse of column 2 code with column 1 code, and so on. The national correct coding initiative ncci also known as cci was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. Most commonly used cci edits for pt, ot, and slp private practice settings some things go better together. Ncci procedure to procedure code pair edits are automated prepayment edit that prevent improper payment when certain codes are submitted together for part b covered services. Column 1column 2 correct coding edits and mutually exclusive code mec edits. Understanding outpatient edits and applying modifiers june 5, 2017 jean russell, ms, rhit epoch health solutions, llc agenda the medicare outpatient code editor oce national correct coding initiative medically unlikely mue edits procedure to. In order to simplify the use of ncci edit files two tables, on april 1, 2012, cms consolidated these two edit files into the column onecolumn two correct coding edit file. Policy name cci editing summary this policy describes. National correct coding initiative policy manual for. Many procedure codes should not be reported together because they are mutually exclusive of each other.
Ncci edits vs mutually exclusive edits medical billing. Medical coding what is ncci edits how to ncci edit. Cpt manual or ncci program instructions 4 mutuallyexclusive procedures 5 sequential procedures 6 cpt separate procedure definition 7 more extensive procedure 8 reserved for future use 9 genderspecific procedures 10 standards of medical surgical practice 11 anesthesia service included in surgical procedure 12 laboratory panel deleted. The bundled cpt code will hit an edit that will reject the code from your claim, possibly causing rejection of covered charges as well. A revised annual version of the national correct coding initiative policy manual for medicare services effective january 1, 2020 was posted with a revision date of november 12, 2019.
A modifier indicator of 9 means that an ncci edit does not apply to this code pair. The cms ncci edit reimbursement methodologies are based on correct coding principles. Ncci edits also known as procedure to procedure ptp edits and medically unlikely edits mues units of service. Cci edits for speechlanguage pathology services under medicare part b and medicaid. General clinical editing and payment accuracy guidelines. Services cms developed the national correct coding initiative ncci to promote national correct coding methodologies and to control improper coding that leads to.
Mutually exclusive edits italicized component edits bold national correct coding initiative edits column 1 codes column 2 codes with modifier status of 0 column 2 codes with modifier status of 1 90901 64550 9080490857 90865 90880 91122 g0345 g0347 g0351 g0353 g0354 90911 90901 64550 9080490857 90865 90880 91122 95860. For an explanation of the rationale for ncci edits and as a general reference. If you are billing any of the codes listed, they will be considered mutually exclusive or linked. The column onecolumn two correct coding edits table and the mutually exclusive edits table have been combined into one table and include code pairs that should not be reported together for a number of reasons explained in. If the code in column 2 has a y next to it, you can add modifier 59. The mutually exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations. Review of medicare part b mutually exclusive procedure. Column onecolumn two code pair edits and mutually exclusive code pair edits from the centers for. Understanding cci mutually exclusive designationis critical published on sat feb 01, 2003 because the correct coding initiative cci version 9. How to use the medicare national correct coding initiative. The column onecolumn two correct coding edits table and the mutually exclusive edits mues table have been combined into one table and include code pairs that should not be reported together. Ncci proceduretoprocedure ptp edits, medically unlikely edits mues, and addon code edits. Mutually exclusive edits identifies code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day. Ncci ptp edits prevent inappropriate payment of services that should not be reported together.
The column onecolumn two correct coding edits table and the mutually exclusive edits table include code pairs that should not be reported together for a number of reasons explained in the coding policy manual. Cms identifies some edits as being mutually exclusive, which means they can never be paid separately. An example of a mutually exclusive code pairing is cpt 92607. Services that result in an ncci edit may be denied. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results. The july release of the national correct coding initiative includes only 111 mutually exclusive edits as compared to the 3,698 nonmutually exclusive edits it adds. Combining the two tables simplifies researching ncci ptp edits and online use of ncci tables. An example of a mutually exclusive situation is the repair of an organ that can be.
Also known as national correct coding initiative, correct coding initiative. Table except those that are based on the mutually exclusive and genderspecific criteria in which case the edits are included in the mutually exclusive edit table. Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same patient encounter. Rebundling and ncci edits policy, professional reimbursement policy unitedhealthcare medicare advantage plans. National correct coding initiative edits ncci is used by the centers for medicare and medicaid services cms to promote correct coding. The presence of a hcpcscpt code in a proceduretoprocedure ptp edit or a medically unlikely edits mues value for a hcpcscpt code does not necessarily indicate that the code is covered by any state medicaid program or by all state medicaid programs. Pairs of hcpcscpt codes that are mutually exclusive of one another are identified as code pair edits in the ncci mutually exclusive edit table. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Each chapter includes mutually exclusive codes as well as the column. When procedures edit for being mutually exclusive or for one procedure being included in the code for another procedure, the combination of codes wont pass the ncci edits. Likewise, rehab therapists often perform certain procedures that are similar to one anotherbut they might not know that two or more specific therapy types form edit.
The same holds true for billing 97140 with 95851, 95852, 97164, 97168, 97018, 97530, or 97750. Cms developed its coding policies based on coding conventions defined in the american medical associations cpt manual, national and local policies and edits. I didnt realize i talked about cci edits that much but it is good to know. Here are three more examples demonstrating how to unbundle ncci edits. Claimsxten rule descriptions blue cross blue shield of texas. Ncci code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for part bcovered services. I hear you mention cci edits quite a bit, can you give me a brief overview explanation of what cci edits are and how i can access them.
In one mutually exclusive edit, new cpt 29873 arthroscopy, knee, surgical. How to use the medicare national correct coding initiatie ncci tools mln booklet. Lineitem rejections might state the service is mutually exclusive, incidental to. Medicas cci editing policy includes code pairs which are not. All other edits were assigned to the column onecolumn two correct coding edit file. Manual for medicare services are now available on this page in the ncci. How cci edits affect billing mutually exclusive edits when a cpt code is part of another code and is considered nonpayable if the two codes are reported together on the same day of service by the same provider, unless a cci edit allows use of an appropriate modifier.
Abbreviation for national correct coding initiative. The ncci is updated quarterly and is available to the public at. Define pairs of healthcare common procedure coding system hcpcs and current procedural terminology cpt codes that should not be reported together. There are no modifiers associated with ncci that are allowed. The column onecolumn two correct coding edits table and the mutually exclusive edits table have been combined into one table and include ptp code pairs that should not be reported together for a number of reasons explained in the coding policy manual. Ncci proceduretoprocedure ptp editsmedically unlikely edits mue, s, and addon code edits. Ptp edits and mues are contained in a single table that includes the ptp code pairs that should not be reported together for a number of reasons, as explained in the ncci coding policy manual.
Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same beneficiary encounter. Medical coverage policy claim editing ncci and rvu. These data replace the medicaid ncci edit files from previous calendar quarters. Cms maintains tables of code pair edits and updates these tables on a quarterly basis. An example of a mutually exclusive situation is the repair of an organ that can be performed by two different methods. There are ncci edits for physicians and outpatient facilities. The column onecolumn two correct coding edits table and the mutually exclusive edits table have been. Mutually exclusive edits consist of combinations of procedures that differ in technique or approach but lead to the same outcome. Medicares national correct coding initiative office of inspector code pairs called mutually exclusive edits which prevent payment for services. Understanding outpatient edits and applying modifiers june 5, 2017 jean russell, ms, rhit epoch health solutions, llc agenda the medicare outpatient code editor oce national correct coding initiative medically unlikely mue edits procedure to procedure ptp edits add. In some instances, the combination of procedures may be anatomically impossible. National correct coding initiative ncci and medically unlikely edits mues at a national level, medicare identifies individual services that are components of more inclusive services using national correct coding initiative ncci edits.
The column onecolumn two correct coding edits table and the mutually exclusive edits mues table have been combined into one table and include. Policy data includes workers compensation voluntary and assigned risk coverage information issued by the insurer to. Dec 01, 2016 for the mutually exclusive edits only, to promote correct coding and to deter providers from reporting codes improperly, cms decided at national correct coding initiative ncci implementation on january 1, 1996 that the payable code should, in general, be the procedure with the lesser work relative value unit rvu, which often results in. Additionsrevisions to the manual have been italicized in red font.
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