Effective Use of NCD, LCD, and NCCI Edits for Clean Claims

1. Effective Use of NCD, LCD, and NCCI Edits for Clean Claims Presented By Trenda Davis, CPC, Auditor; SuperCoder.com 1

2. Course Objective • Definition of NCCI (CCI), NCD and LCD and their importance • How NCCI edits impact CPT coding • ICD-10-CM updates that will affect NCD and LCD • Helpful tips to send out clean claims • Learn tools and resources that will help with the up-to-date coding changes 2

3. National Correct Coding Initiative • National Correct Coding Initiative (NCCI) • Correct Coding Initiative (CCI) • Created by CMS to “promote national correct coding methodologies and to control improper coding leading to inappropriate payments on Part B claims.” 3

4. National Correct Coding Initiative Purpose of NCCI: • Prevent providers from reporting two procedures together for which there is a third separate code that describes the combination of services • Require providers to report the complete procedure code instead of reporting multiple codes that describe parts of the complete procedure • Require providers to report only the more extensive version of the procedure performed 4

5. National Correct Coding Initiative Procedure to Procedure (PTP) edits • Automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B covered services. • 2 provider type choices: • Practitioner • Hospital 5

6. Example of PTP Edit 6

7. Example of PTP Edit 7

8. National Correct Coding Initiative Medically Unlikely Edits (MUE) • Maximum number of units of services allowable under most circumstances for a single HCPCS/CPT code billed by a provider on a date of service • 3 provider type choices: • Practitioner • Durable Medical Equipment • Facility Outpatient 8

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10. Example Your practice bills CPT® code 11004 with 3 units Will this claim be paid or denied? 10

11. National Correct Coding Initiative CCI-associated modifiers include: • Anatomical Modifiers: • TA-T9 • FA-F9 • E1-E4 • LT and RT • Global Surgery Package: • Modifier - 24, 25, 57, 58, 78, 79 • Other Applicable Modifiers: • Modifier - 27, 59, 91, XE, XS, XP, XU 11

12. National Correct Coding Initiative Updated Quarterly: • 1st Quarter: January 1st - March 31st • 2nd Quarter: April 1st - June 30th • 3rd Quarter: July 1st - September 30th • 4th Quarter: October 1st - December 31st • Make sure your practice is aware of update changes to ensure your practice has efficient and clean claims submission. 12

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16. http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.htmlhttp://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html 16

17. National Correct Coding Initiative Organized in Two Tables: • Column 1 / Column 2 Correct Coding Edits • Mutually Exclusive Code (MEC) Edits 17

18. Example 18

19. Example 19