Title: Effective Use of NCD, LCD, and NCCI Edits for Clean Claims
1Effective Use of NCD, LCD, and NCCI Edits for
Clean Claims Presented By Trenda Davis, CPC,
Auditor SuperCoder.com
2Course 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
3National 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.
4National 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
5National 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
6Example of PTP Edit
7Example of PTP Edit
8National 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
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10Example
Your practice bills CPT code 11004 with 3
units Will this claim be paid or denied?
11National 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
12National 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.
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16http//www.cms.gov/Medicare/Coding/NationalCorrect
CodInitEd/index.html
17National Correct Coding Initiative
- Organized in Two Tables
- Column 1 / Column 2 Correct Coding Edits
- Mutually Exclusive Code (MEC) Edits
18Example
19Example
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