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

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

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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.

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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

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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

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Example of PTP Edit
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Example of PTP Edit
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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

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

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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.

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http//www.cms.gov/Medicare/Coding/NationalCorrect
CodInitEd/index.html
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National Correct Coding Initiative

• Organized in Two Tables
• Column 1 / Column 2 Correct Coding Edits
• Mutually Exclusive Code (MEC) Edits

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Example
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Example
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