Updates for NCCI Edit Coding Policy Manual for 2017

The National Correct Coding Initiative (NCCI) was developed by the Center for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies. The NCCI also aims at controlling improper coding, which leads to inappropriate payments in Medicare Part B claims.

The coding policies of the CMS were based on the coding conventions as defined in the CPT Manual American Medical Association’s; coding guidelines developed by national societies; national and local policies and edits; a review of current coding practices; and analysis of standard medical and surgical practices.

The CMS annually updates the NCCI Coding Policy Manual for Medicare Services. These updates are known as NCCI edits, which are of two types:

  • NCCI Procedure-to-Procedure (PTP) Edits

The PTP edits prevent improper payments if incorrect code combinations are reported. The NCCI contains two tables of edits, one for physicians/practitioners and the other one for outpatient hospital services. The Mutually Exclusive Edits table and the Column One/Column Two Correct Coding Edits table have been combined into a single table and include PTP code pairs, which must not be reported together for reasons explained in the Coding Policy Manual.

  • Medically Unlikely Edits (MUEs)

The MUEs define for each Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code the maximum Units of Service (UOS), which a provider would report for a single beneficiary, under most circumstances on a single date of service. The MUEs prevent improper payments if services are reported with incorrect UOS.

2017 Updates for NCCI Edit Coding Policy Manual

Some of the Updates for NCCI Edit Coding Policy Manual include:

Chapter 1 NCCI PTP edits and MUEs are based on services provided to the same beneficiary, by the same physician, on the same date of service.

Also, physicians must not cause any inconvenience to the beneficiaries nor increase any risks to them by performing services on different dates to avoid NCCI PTP edits or MUEs.

Chapter 2 Anesthesiologist provide critical care services under certain circumstances. Thus, Certified Registered Nurse Anesthetists (CRNAs) might be paid for the evaluation and management services in critical care area if the state law and/or regulation permits them of providing such services.
Chapter 8 CPT codes 6231062319 were replaced by codes 6232062327, where codes 62321, 62323, 62325, and 62327 are for injections with fluoroscopic or CT guidance, and codes 62320, 62322, 62324, and 62326 are for injections without imaging guidance.
Chapter 9 To assess potential complications or procedure completeness by performing a comparative imaging study, the professional component of the post-procedure imaging study CPT code is not payable separately and should not be reported. However, the technical component of the post-procedure imaging study CPT code might be reported.
Chapter 10 CMS policy prohibits separate payments for duplicate testing or testing for the same analyte by more than one methodology.

For more insights on the changes that you might expect in the NCCI Edit Coding Policy Manual in 2017, attend this Webinar by expert speaker, Duane C. Abbey, Ph.D., who is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in health care consulting and related areas. You will also learn about the compliance issues surrounding hospital use of the updated coding/billing policies.

Leave a Reply

Your email address will not be published. Required fields are marked *